The research rotation: competency-based structured and novel approach to research training of internal medicine residents

Research productivity of RANZCR radiation oncology trainees from 2014 to 2023

INTRODUCTION

The aim of this study was to describe the research productivity among RANZCR Radiation Oncology (RO) trainees.

METHODS

Publicly available data on RO fellows, who were awarded the RANZCR fellowship between July 2014 and June 2023, was extracted from the RANZCR Annual Reports. Fellows who had qualified overseas and did not undertake full RANZCR training were excluded. A PubMed search was performed for publications by each fellow in the 5 years prior, and 6 months, after the estimated completion of training. Research productivity was defined as the number of first-author and any-author publications per trainee.

RESULTS

In total, 168 eligible RO fellows were included in this study. 104 (62%) and 118 (70%) fellows had first-author and any-author publications during training, respectively. A total of 203 first-author and 308 unique any-author publications were identified, with mean first-author and any-author publications per trainee of 1.21 (SD = 2.37) and 2.02 (SD = 3.71), respectively. Trainee research was most commonly published in JMIRO (34% of first-author and 27% of any-author publications). There were significant differences in the number of first-author publications by gender (P = 0.04) and training jurisdictions (P = 0.03). There were also differences in the number of any-author publications by gender (P = 0.002) and training jurisdictions (P = 0.03). There was a significant increase in any-author publications over the 9-year study period (P = 0.005).

CONCLUSION

This is the first study evaluating research productivity among RO fellows during training. We identified disparities in research productivity by gender and training jurisdictions. This offers opportunities to tailor efforts to better support a vibrant and productive research culture across the RO training program.

All of whom? Limitations encountered using All of Us Researcher Workbench in a Primary Care residents secondary data analysis research training block

OBJECTIVES

The goal of this case report is to detail experiences and challenges experienced in the training of Primary Care residents in secondary analysis using All of Us Researcher Workbench. At our large, urban safety net hospital, Primary Care/Internal Medicine residents in their third year undergo a research intensive block, the Research Practicum, where they work as a team to conduct secondary data analysis on a dataset with faculty facilitation. In 2023, this research block focused on use of the All of Us Researcher Workbench for secondary data analysis.

MATERIALS AND METHODS

Two groups of 5 residents underwent training to access the All of Us Researcher Workbench, and each group explored available data with a faculty facilitator and generated original research questions. Two blocks of residents successfully completed their research blocks and created original presentations on "social isolation and A1C" levels and "medical discrimination and diabetes management."

RESULTS

Departmental faculty were satisfied with the depth of learning and data exploration. In focus groups, some residents noted that for those without interest in performing research, the activity felt extraneous to their career goals, while others were glad for the opportunity to publish. In both blocks, residents highlighted dissatisfaction with the degree to which the All of Us Researcher Workbench was representative of patients they encounter in a large safety net hospital.

DISCUSSION

Using the All of Us Researcher Workbench provided residents with an opportunity to explore novel questions in a massive data source. Many residents however noted that because the population described in the All of Us Researcher Workbench appeared to be more highly educated and less racially diverse than patients they encounter in their practice, research may be hard to generalize in a community health context. Additionally, given that the data required knowledge of 1 of 2 code-based data analysis languages (R or Python) and work within an idiosyncratic coding environment, residents were heavily reliant on a faculty facilitator to assist with analysis.

CONCLUSION

Using the All of Us Researcher Workbench for research training allowed residents to explore novel questions and gain first-hand exposure to opportunities and challenges in secondary data analysis.

Attitudes on data reuse among internal medicine residents

Background

NYU Langone Health offers a collaborative research block for PGY3 Primary Care residents that employs a secondary data analysis methodology. As discussions of data reuse and secondary data analysis have grown in the data library literature, we sought to understand what attitudes internal medicine residents at a large urban academic medical center had around secondary data analysis. This case report describes a novel survey on resident attitudes around data sharing.

Methods

We surveyed internal medicine residents in three tracks: Primary Care (PC), Categorical, and Clinician-Investigator (CI) tracks as part of a larger pilot study on implementation of a research block. All three tracks are in our institution's internal medicine program. In discussions with residency directors and the chief resident, the term "secondary data analysis" was chosen over "data reuse" due to this being more familiar to clinicians, but examples were given to define the concept.

Results

We surveyed a population of 162 residents, and 67 residents responded, representing a 41.36% response rate. Strong majorities of residents exhibited positive views of secondary data analysis. Moreover, in our sample, those with exposure to secondary data analysis research opined that secondary data analysis takes less time and is less difficult to conduct compared to the other residents without curricular exposure to secondary analysis.

Discussion

The survey reflects that residents believe secondary data analysis is worthwhile and this highlights opportunities for data librarians. As current residents matriculate into professional roles as clinicians, educators, and researchers, libraries have an opportunity to bolster support for data curation and education.

Money Talks: The Shifting Effect of Limiting Monetary Incentives for Urology Resident Research

OBJECTIVE

To assess incentive changes on resident publication behavior. In 2020, we demonstrated the positive effect of an unlimited $1000 publishing incentive for Urology residents. Following this publication, institutional changes led to a limit of a single $1000 publishing incentive per resident per year.

METHODS

The PubMed database was assessed to quantify average resident primary authorship and average overall publications. Average primary authorships and total PubMed listings were then compared by year before any incentive (June 2008-June 2016), during unlimited incentive (July 2016-October 2020), and after the limited financial incentive (November 2020-June 2023).

RESULTS

Scholarly activity from 30 out of 30 possible residents was evaluated. The average PubMed research participation for the program per year increased significantly from 2.44 preincentive to 8.0 when the incentive was unlimited but decreased to 4.0 when the incentive was limited (P = .026). Similarly, the average PubMed primary resident authorships per year increased from 1.0 preincentive to 6.25 during the unlimited incentive period but decreased to 2.0 when the incentive was limited (P < .001).

CONCLUSION

Our data showed an unlimited monetary incentive resulted in a significant increase in average primary resident authorship and average resident participation for publications to PubMed. The limited monetary incentive model resulted in a significant decrease on resident publication and participation in research compared to unlimited incentives. However, limited monetary incentives have a positive, though restricted, effect on Urology resident publication and participation in research compared to no incentive.

Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation

Importance

Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated.

Objective

To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians.

Design, Setting, and Participants

This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022.

Intervention

In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non-call-based rotations.

Main Outcomes and Measures

The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen's D was used to estimate standardized mean differences (SMDs).

Results

Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], -6.78 [95% CI, -9.24 to -4.32]) and adjusted DP scores (MD, -3.81 [95% CI, -5.29 to -2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, -0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted.

Conclusions and Relevance

In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.

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.

Impact Evaluation of a Resident-Driven Research Training Workshop in Idaho: A Feasibility Study

Objectives

Engagement in research activities is a critical component of clinical residency training. It is vital to build research capacity of residents to help interpret evidence-based medicine and design quality improvement projects. A mixed methods study was conducted to assess the impact of a 1-day research training workshop conducted at Eastern Idaho Regional Medical Centre, Idaho in May 2022. The workshop was targeted to improve the research knowledge of current clinical residents of Internal Medicine and Family Medicine.

Methods

Workshop comprised of expert presentations, with assessment of difference in knowledge with a pretest and post-test. The sessions were organized around the core competencies of Institute of Medicine. Suggestions were also gathered from the audience. A pretest and post-test based on 13 questions was administered to the participants to assess change in research-related knowledge. Comments and suggestions of the participants were also recorded. Wilcoxon rank test was applied to determine statistical difference across each question and cumulative knowledge score. Conventional content analysis was applied to explore the comments and feedback.

Results

The mean score of participants improved across all 12 questions. Statistically significant results were observed for the questions about types of studies qualifying as qualitative research. The cumulative score of participants increased in the post-test from 8.57 to 9.35. The participants gained new knowledge (94.3%), and felt more comfortable in application of research methods (74.3%). Encouraging feedback was obtained from the audience. They stated that they had benefited from the workshop and felt more prepared and motivated to indulge in scholarly activities.

Conclusion

The study shows improvement in research-related knowledge of clinical residents attending a 1-day training workshop. We recommend inclusion of such workshops in the curriculum of residents for skill building and enhanced indulgence in research activities in order to prepare them as future leaders in quality improvement, health policy, and hospital administration.

"Not just a checkbox": A qualitative study of the resident scholarly experience

Objectives

Scholarship is a requirement of residency training; however, the scholarly productivity of trainees is highly variable. The purpose of this study was to explore the perspectives of residents who have been highly productive in scholarship.

Methods

We performed a qualitative study using a constructivist-interpretivist paradigm and conducted semistructured interviews at seven Accreditation Council for Graduate Medical Education-accredited emergency medicine residency programs in the United States. We included sites of diverse locations and training formats (PGY-1 to -4 vs. PGY-1 to -3). Program leadership identified residents with high levels of scholarly productivity at their institutions. We used purposive sampling to seek out residents with diversity in gender and PGY level. Two researchers independently performed a thematic analysis of interview transcripts. Discrepancies were resolved through in-depth discussion and negotiated consensus.

Results

We invited 14 residents and all consented to be interviewed. Residents felt scholarship enhanced their knowledge and skills, grew collaborative networks, and provided personal fulfillment and external rewards. Scholarship positively impacted their careers by focusing their professional interests and informing career decisions. Participants identified individual and institutional facilitators of success including personal prior knowledge and skills, project management skills, mindset, protected time, mentorship, and leadership support. Challenges to conducting scholarship included lack of time, expertise, and resources. Participants acknowledged that participating in scholarly activities was hard work and recommended that residents seek out quality mentorship, work on projects that they are passionate, start early, and be persistent in their efforts. Participants' advice to faculty supporting resident scholarship included recommendations to allow resident autonomy of projects, provide scholarly opportunities, and be responsive to trainee needs.

Conclusions

Participants in this study highlighted benefits of participating in scholarly activity as well as challenges and strategies for success. These results can inform residencies seeking to enhance the scholarly experience of trainees.

Recommended Sports Medicine Fellowship Scholarly Activity Curriculum

ABSTRACT

Scholarly activity requirements for primary care sports medicine fellowship programs are increasing and the current Accreditation Council for Graduate Medicine Education (ACGME) expectations for fellows and core faculty are more demanding than those found in medicine residencies. A review of existing literature fails to identify any published guidelines on how to pursue scholarly activity within the sports medicine fellowship year. Such a deficiency may be critical for fellowship programs that are struggling to produce scholarship with a 1-year timeframe. This document intends to be a resource for all sports medicine fellowship programs by defining acceptable pieces of scholarly activity, delineating how a project may be completed during fellowship, and outlining avenues to educate others in the topic of choice. Adoption of this curriculum will guide fellows to meet ACGME-mandated scholarship requirements while assisting core faculty in meeting academic promotion criteria.

Views of medical residents on a research training program: A qualitative study

INTRODUCTION

The American University of Beirut Medical Center (AUBMC) developed the Fellowship and Residency Research Program (FRRP) to provide residents and clinical fellows with a supervised and structured research experience. The objective of this study was to explore the views of FRRP participants about the training program and how to enhance it.

METHODS

In 2018, we conducted a qualitative study targeting residents where we invited potential participants through email and via snowball sampling. We continued the data collection until we reached data saturation with 21 participants (N = 21) and used thematic analysis to identify emerging themes.

RESULTS

Thematic analysis generated four emerging themes: one related to the expectations of residents, while the remaining three themes related to how the program is working to meet those expectations, specifically: coordination, mentorship, and capacity building. For these three latter themes, we discussed the strengths and challenges related to each. In terms of coordination, few residents complained that the deadlines to submit deliverables are not evenly distributed across the years. In terms of mentorship, participants appreciated the flexibility in choosing the mentor. In terms of capacity building activities, participants found the lecture series, both real time and virtual, to be helpful. Finally, participants pointed out that the FRRP program should be mandatory.

DISCUSSION

To provide residents and clinical fellows with a supervised and structured research experience, we have built on our findings to introduce several changes to our program such as ensuring the availability and commitment of faculty mentors, and providing capacity building activities to the program participants.

Dermatology residency research policies: A 2021 national survey

BACKGROUND

In this follow-up study to previous work, the authors survey the availability of key measures and resources pertaining to residency research in U.S. Accreditation Council for Graduate Medical Education-accredited dermatology residency programs, including potential policy changes following the COVID-19 pandemic.

OBJECTIVE

The chief objective of this survey was to evaluate and compare dermatology programs' resident research requirements and guidelines.

METHODS

This cross-sectional study employed a 13-item survey administered online in early 2021 to assess the degree to which dermatology residency programs require and support their new physician graduates in scholarly research endeavors.

RESULTS

A total of 32 program directors representing 30 dermatology residency programs (30 of 138 accredited programs contacted [22%]) responded to the survey. Almost all programs described quality improvement project requirements for residents and were able to provide funding for resident conference participation. Most programs also reported resident publication requirements and the availability of research electives. However, the vast majority did not have required research rotations or a formal mentorship program. The COVID-19 pandemic did not have a substantial impact on residency research requirements.

CONCLUSION

Our survey provides objective data about the current dermatology resident research requirements across the United States. These findings may prove valuable to prospective applicants, residency programs, and accrediting agencies in improving, advancing, and structuring dermatology residency guidelines and resources with the aim of encouraging new physician trainees to pursue research.

Defining GME Librarianship: Creating and Developing a New Graduate Medical Education Library Program and Librarian Position

An academic research institution and a corporate hospital system formed a new graduate medical education (GME) consortium. The consortium objectives were to increase the scholarly activity of the residents and fellows in a national hospital system's GME residency program to match the requirements set forth by the Accreditation Council for Graduate Medical Education. A GME librarian position was created specifically to serve the GME research programs at Florida area hospitals to help with this objective. This paper describes the experience, activities, and lessons learned from the creation of an entirely new GME library program and librarian position for a nine-hospital region in Florida.

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.

Podiatric Medicine and Surgery Resident-Authored Publications in The Journal of Foot and Ankle Surgery: A Systematic Review

Since its introduction into the medical community, the Podiatric Medicine and Surgery residency has strived to graduate the most advanced and learned foot and ankle surgeons. From increasing length of training, to assuring didactics and education are sufficiently incorporated into the residency, the Council on Podiatric Medical Education has overseen this transition. One area of interest, podiatric medicine and research, remains central to this training and contributes to the field of foot and ankle surgery through journal publications. The purpose of this review was to identify Podiatric Medicine and Surgery resident-authored publication rates, trends, and geographic distribution. All published case reports, original research articles, review articles, and tips, quips, and pearls in The Journal of Foot and Ankle Surgery from January 2009 to December 2018 were reviewed. Podiatric Medicine and Surgery residents comprised 8% of all authors. Residents contributed to and published as first authors in 22% and 11% of all manuscripts, respectively. An increasing trend in resident authors, resident-authored manuscripts, and resident-first-authored manuscripts was observed. From before the mandated 3-year residency to after, the proportion of resident-authored manuscripts to all manuscripts declined from 9.99% to 7.21%; however, among these resident-authored publications, the rate of first-authorship increased from 45.32% to 51.36%. To the best of our knowledge, this is the first and only study to examine publication rates among foot and ankle surgery residents.

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.

Research Productivity of Canadian Radiation Oncology Residents: A Time-Trend Analysis

(1) Background: Research productivity is a mandatory component of Canadian radiation oncology (RO) resident training. To our knowledge, Canadian RO resident research publication productivity has not previously been analysed. (2) Methods: We compiled a 12-year database of RO residents in Canadian training programs who completed residency between June 2005 and June 2016. Resident names and dates of training were abstracted from provincial databases and department websites and were used to abstract data from PubMed, including training program, publication year, journal, type of research, topic and authorship position. Residents were divided into four time periods and the linear trend test evaluated publication rates over time. Univariable and multivariable logistic regression analyses were performed to identify authorship predictors. (3) Results: 227 RO residents representing 363 publications were identified. The majority were first-author publications (56%) and original research (77%). Overall, 82% of first-author, and 80% of any-author articles were published in resident year 4 or higher. Mean number of publications for first-author and any-author positions increased significantly over time (p = 0.016 and p = 0.039, respectively). After adjusting for gender and time period, large institutions (> 3 residents per year) trended toward associations with more first-author publications (odds ratio (OR): 2.44; p = 0.066) and more any-author publications (OR: 2.49; p = 0.052). No significant differences were observed by gender. (4) Conclusions: Canadian RO resident publication productivity nearly doubled over a 12-year period. The majority of publications are released in the last 2 years of residency, and larger residency programs may be associated with more publications. These findings serve as a baseline as programs transition to Competency Based Medical Education (CBME).

Clinicians’ Publication Output: Self-Report Survey and Bibliometric Analysis

The uncertainties around disease management and control measures have not only motivated clinicians to keep abreast of new evidence available in the scholarly literature, but also to be rigorously engaged in medical research, dissemination and knowledge transfer. We aimed to explore clinicians’ publication output from the Malaysian perspective. A self-report survey and bibliometric analysis was conducted. A total of 201/234 clinicians participated in the survey. Items consisted of demographics, researching habits, publication output and level of importance of journal selection metrics. Descriptive, bivariate and multivariate analyses were conducted. Bibliometric analysis using retrieved records from PubMed between 2009 and October 2019 was conducted and co-occurrence and co-authorship analyses were executed. Self-reported publication output was 16.9%. In the logistic regression model, publication output was significantly higher amongst consultants or clinical specialists (aOR = 2.5, 95% CI 1.1–10.0, p = 0.023); clinicians previously involved in research (aOR = 4.2, 95% CI 1.5–11.4, p = 0.004); clinicians who ever used reference citation managers (aOR = 3.2, 95% CI 1.3–7.7, p = 0.010); and journal publication speed (aOR = 2.9, 95% CI 1.2–7.1, p = 0.019). Most clinicians published original research papers (76.4%) in international journals (78.2%). Published papers were mostly observational studies, genetic, stroke and health services or systems research. In conclusion, socio-demographics, researching habits and journal selection metrics were significantly associated with self-reported publication output. Real outputs from bibliometrics were predominantly focused across five clusters.

Structure and evaluation of a residency research program in a university hospital

BACKGROUND

Most academic medical institutions lack a structured program that provides residents with an in-depth research training. The objectives of this paper are to describe a comprehensive residency research program at a university hospital, and to assess the pre- post-self-assessment of research capabilities of resident for the evaluation of the program.

METHODS

The residency research program (RRP) was implemented in 2011 as an essential component of the residency program at the American University of Beirut Medical Center. Categorical residents are required to carry out a research project and go through all the steps of the research process from identifying a topic to writing a manuscript. As for evaluating the program, data were collected from residents who graduated between 2014 and 2016 using a questionnaire, which included the overall evaluation of the program, self-assessment on research-related tasks pre- and post- joining the program, as well as general recommendations. The mean scores on the five-point Likert scale were transformed into percentages (0-100%). The average was calculated and the difference in the means was reported.

RESULTS

Overall, 103 residents from the different clinical departments were included in this study. Residents' self-assessment showed a 19.3% improvement in research-related tasks before and after completion of the RRP (P < 0.0001). Most of the residents have either published or are in the process of publishing their projects (34 and 55.3%, respectively). Time management was the most reported challenge. Generally, the program was evaluated positively.

CONCLUSION

The RRP is a unique, well-structured program, encompassing residents from various clinical departments, which enhances residents' research capabilities.

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.

Scholarly training objectives and requirements for paediatric residents in Canada

In the absence of national standards for scholarly requirements, paediatric resident training varies significantly across Canadian programs. This variability may contribute to significant differences in trainee experiences and productivity. A panel of coordinators of paediatric resident research programs from across Canada met in 2014, to share experiences and identify barriers to successful resident scholarly activity. A survey of all programs was completed in 2015. A scoping review and series of meetings led to the development of a proposed list of expectations, timelines for successful completion and consequences for not completing a scholarly project. We propose a harmonized list of scholarly competencies and activities for paediatric residents in Canada to accomplish before completing their training. We also propose that programs implement standardized timelines and consequences in the event that a resident does not meet their program's scholarly expectations.

An Evaluation of the Scholarly Activity Guidance and Evaluative (SAGE) Program

This article was migrated. The article was marked as recommended. Objective: To evaluate the SAGE program five years following implementation. Methods: Our program evaluation was based on Guskey's five-level framework for evaluation of professional development. Residents and supervisors were invited to participate. Participants' reactions, learning, perceived organization support, use of new knowledge or skills and learning outcomes were examined through questionnaires and interviews. Results: 54% of residents and 65% supervisors were mostly or very satisfied with SAGE. 75% of residents felt there was moderate or great institutional support of resident research. Most residents and supervisors reported satisfaction with institutional research resources. Residents participating in the SAGE program reported a greater number of grant submissions and awards, but fewer conference presentations. Conclusions: SAGE has been well received by residents and supervisors. Findings suggest the program has fostered the development of research abilities and improved institutional support. It remains unclear if demonstrable learning outcomes have increased since program implementation. We also identified several barriers which will serve as targets for program improvement in future.

Starting Line for Scholarly Activity in New Residency Programs: Lessons Learned for Institutional Success

BACKGROUND

One focal point of Graduate Medical Education (GME) is scholarly activity and its integration into clinical practice by evidence-based learning. Program directors and educational leaders view scholarly work as the foundation for continuing resident education; however, the high demand of scholarly activity can be cumbersome for newly accredited residency programs.

METHODS

We reviewed all scholarly activity over a 2-y period (2015-2017) involving three new GME programs at a single institution (internal medicine, surgery, and transitional year). A voluntary anonymous online survey was distributed to all residents to assess their perceptions and expectations regarding research, review prior research experience, and analyze any barriers or successes within the research program.

RESULTS

The survey was distributed to 61 residents with a response rate of 59% (36/61), including postgraduate years 1-5. Respondent demographics included males (55.6%), ages 26-30 y (63.9%), and respondents commonly being postgraduate year-1 (58.3%) level. In total, 171 scholarly activities were recorded. Survey review of resident basic research knowledge, concepts, and experience included preresidency research (91.7%), prior scholarly activity (79.2%), and interest to meet career goals (66.7%). Barriers or delays in research were lack of structured curriculum (50%), technical support (45.8%), research experience (37.5%), and interest (33%).

CONCLUSIONS

Newly accredited GME training programs can avoid an unnecessary institutional deficiency in scholarly activity by developing a structured and comprehensive research curriculum. Resident engagement, developing a mentor-mentee relationship, and research experience before residency can allow a successful research program.

Critical Care PGY-2 Graduate Perceptions and Practices Regarding Residency Project Publication

Objective. To characterize the practices and perceptions of recent post-graduate year 2 (PGY2) critical care pharmacy (CCP) residents surrounding the completion and publication of their primary research project. Methods. Potential factors and perceptions influencing primary research project publication success were identified and incorporated in a validated electronic survey distributed to 2011 and 2012 PGY2 CCP residency program graduates. Results. Among the 94/124 (76%) respondents, 26% had published their research project (67% were first authors; 50% were successful on first submission), while 36% still planned to pursue publication, and 38% had no plans for their manuscript. Factors more commonly reported by publishing (vs. non-publishing) PGY2 graduates included: publication of their PGY1 research project, any publication during the PGY2 year, and national presentation of the PGY2 research project. Perceptions associated with research project publication success were a higher degree of self-motivation to publish, post-PGY2 mentor support, project's publication deemed important to post-PGY2 employer, adequate training for manuscript submission, and adequate time during residency for manuscript completion. Two factors, ≥1 publication during PGY2 [odds ratio (OR)=3.7; 95% confidence interval (CI) 1.3, 10.2] and research project presentation at a national conference (OR=4.5; 95% CI 1.2, 16.9); and two perceptions, self-motivation to publish (OR=8.1; 95% CI 1.7, 37.7) and post-PGY2 mentor support (OR=3.3; 95% CI 1.1, 9.8) were independently associated with publication success. Conclusion. Only one-quarter of PGY2 CCP residents published their primary research project. PGY2 programs should consider those factors associated with research project publication success when formulating strategies to increase resident publication rates.

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.

Barriers to Completion of Research Projects Among Orthopaedic Trainees

INTRODUCTION & AIM

It is a requirement of the Australian Orthopaedic Association (AOA) training program that surgical education training (SET) trainees demonstrate competency in clinical or basic science research as part of their teaching curriculum. The aim of this study is to identify barriers in completing research by the Victorian and Tasmanian Region AOA SET trainees.

METHODS

We designed a short qualitative survey which was distributed to all Victorian and Tasmanian orthopaedic trainees through the AOA. The survey consisted of 18 questions most of which were based on a 5-point Likert scale with options to add comments based on individual experience.

RESULTS

Thirty-two (61%) orthopaedic trainees responded to the survey. Two did not give consent for their data to be used. Trainees were more likely to abandon their research projects if they had insufficient time to complete a project (p = 0.01), had fewer opportunities to take part in research (p = 0.011), were unable to complete a research project within their hospital rotation (p = 0.024), and did not have access to funding (p = 0.025).

CONCLUSION

A large amount of research is abandoned by trainees. The barriers to research completion are similar to those found in the literature, however, not all barriers identified in the literature were found to be barriers to the Victorian and Tasmanian Orthopaedic trainees. By identifying barriers to research completion within training programs, we hope to assist efficiency and help improve the likelihood of project completion as well as assist mentors in their guidance of trainees while conducting research.

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.

Longitudinal Experience With a Transparent Weighted Lottery System to Incentivize Resident Scholarship

BACKGROUND

Promoting resident scholarship is important to programs. Positive Peer-Pressured Productivity (P-QUAD) is a dual incentive model that combines increased transparency through awareness of peers' engagement in scholarship, with a weighted cash lottery where tickets are earned for various dimensions of academic success (ie, 1 point/ticket for an abstract submission up to 6 for manuscript acceptance).

OBJECTIVE

We explored whether a weighted lottery system contributes to sustained increases in academic productivity in a residency program.

METHODS

We implemented P-QUAD in 1 pediatrics residency program in July 2015. Residents reported their scholarship submissions/acceptances for the prior year, establishing a program baseline. During the 2-year intervention, residents logged their academic submissions/acceptances on a web interface where they could view real-time scores and the work of their peers. At the end of each academic year, we compared P-QUAD points for each category to baseline.

RESULTS

During the intervention, 31% of residents (68 of 218) reported engaging in scholarship. Using P-QUAD was acceptable to most residents. Engagement in scholarship across the program, as measured by total P-QUAD score, increased 53% from baseline (329 versus 504 points per year). Mean submission and acceptance rates for individual residents reporting research through P-QUAD increased across all categories, ranging from 19% for abstract submissions (1.62 to 1.93 per year) to 275% (0.24 to 0.90 per year) for accepted manuscripts.

CONCLUSIONS

The residency program sustained gains in academic productivity at the program-wide and participating resident level in the 2 years since implementing P-QUAD.

Scholarly Activity Training During Residency: Are We Hitting the Mark? A National Assessment of Pediatric Residents

OBJECTIVE

Participation in scholarly activity (SA) is an Accreditation Council for Graduate Medical Education requirement. Our previous research with program directors (PDs) suggests that pediatric SA training is variable and suboptimal. To help programs better meet requirements, our objective was to understand the resident perspective regarding SA training, including factors associated with satisfaction and productivity.

METHODS

We conducted cross-sectional surveys of second- and third-year pediatric residents and PDs at 22 diverse programs in 2016. Surveys assessed resident demographics, career intentions, program characteristics, beliefs, barriers, satisfaction, and productivity, defined as SA accepted at a regional or national meeting, for publication, or grant funding. Data were analyzed using descriptive statistics and multivariable logistic regression.

RESULTS

A total of 464 (60.2%) of 771 residents and 22 PDs (100%) responded. Most residents believed that residents should participate in SA (n = 380, 81.9%). However, only 37.9% (n = 175) were extremely or very satisfied with their training. Residents who reported that training to conduct research (adjusted odds ratio [AOR]  = 1.9, 95% confidence interval [CI] 1.1-3.5), availability of a research curriculum (AOR = 1.9, 95% CI 1.2-3.1), and adequate faculty mentorship (AOR = 2.5, 95% CI 1.6-4.1) were not barriers were more satisfied. Protected time was associated with satisfaction (AOR = 1.7, 95% CI 1.1-2.7). A total of 43.8% of residents (n = 203) were productive. Productivity was associated with future plans to conduct research (AOR = 3.3, 95% CI 2.1-5.1).

CONCLUSIONS

Residents believe SA training is important. Dedicated program infrastructure, protected time, and adequate mentorship appear to be crucial to improving quality perceptions.

Research 101: An Initiative to Encourage and Facilitate Quality Resident Research in a Military Setting

Objective Describe and evaluate a structured research program initiated at a tertiary Department of Defense (DOD) Medical Training Facility (MTF) to encourage and facilitate the conduct of research investigations, specifically among residents and junior or inexperienced investigators, but applicable for all DOD otolaryngology (ENT) and audiology providers. Methods A new comprehensive program was deployed in the ENT clinic at Madigan Army Medical Center (MAMC) to help improve the research program. Identified gaps in research methods and regulatory training were incorporated into the existing graduate medical education program along with structured mentorship between residents and senior staff. Academic achievements (eg, research protocols, publications, presentations at national/international meetings, and funding) for the ENT clinic were examined from 1992 to 2016, and changes in academic achievements were analyzed for success. Results The implementation of a structured research curriculum improved the number of protocols submitted and the quality of research being accepted for publication (ie, journal impact factor). Funding for research increased significantly to represent a third of the total research portfolio for the entire hospital. Discussion The benefit of employing a research specialist to oversee the resident research experience can greatly influence the quantity and quality of a resident program's research portfolio. Implications for Practice Improving resident research activity can potentially advance the quality of the resident program, help with evidence-based medical approaches, and increase residents' chances of matching for fellowship.

A dedicated scholarly research program in an adult and pediatric neurology residency program

OBJECTIVE

To describe and assess the effectiveness of a formal scholarly activity program for a highly integrated adult and pediatric neurology residency program.

METHODS

Starting in 2011, all graduating residents were required to complete at least one form of scholarly activity broadly defined to include peer-reviewed publications or presentations at scientific meetings of formally mentored projects. The scholarly activity program was administered by the associate residency training director and included an expanded journal club, guided mentorship, a required grand rounds platform presentation, and annual awards for the most scholarly and seminal research findings. We compared scholarly output and mentorship for residents graduating within a 5-year period following program initiation (2011-2015) and during the preceding 5-year preprogram baseline period (2005-2009).

RESULTS

Participation in scholarship increased from the preprogram baseline (24 of 53 graduating residents, 45.3%) to the postprogram period (47 of 57 graduating residents, 82.1%, p < 0.0001). Total scholarly output more than doubled from 49 activities preprogram (0.92/resident) to 139 postprogram (2.44/resident, p = 0.0002). The proportions of resident participation increased for case reports (20.8% vs 66.7%, p < 0.0001) and clinical research (17.0% vs 38.6%, p = 0.012), but were similar for laboratory research and topical reviews. The mean activities per resident increased for published abstracts (0.15 ± 0.41 to 1.26 ± 1.41, p < 0.0001), manuscripts (0.75 ± 1.37 to 1.00 ± 1.40, p = 0.36), and book chapters (0.02 ± 0.14 to 0.18 ± 0.60, p = 0.07). Rates of resident participation as first authors increased from 30.2% to 71.9% (p < 0.0001). The number of individual faculty mentors increased from 36 (preprogram) to 44 (postprogram).

CONCLUSIONS

Our multifaceted program, designed to enhance resident and faculty engagement in scholarship, was associated with increased academic output and an expanded mentorship pool. The program was particularly effective at encouraging presentations at scientific meetings. Longitudinal analysis will determine whether such a program portfolio inspires an increase in academic careers involving neuroscience-oriented research.

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.

Impact of a Dedicated Research Rotation during Ophthalmology Residency

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires that ophthalmology residents participate in scholarly activity during residency. However, residents lack protected time for research.

Objective

To determine the impact of a dedicated research rotation on scholarly productivity and research experience during residency.

Methods

This cohort study compared two groups of ophthalmology residents. Residents who graduated between 2004-2009 did not have dedicated research time and served as control residents (CR) while residents who graduated between 2010-2015 had a dedicated research rotation and served as the intervention group (research residents, RR). Primary outcomes included publications and presentations recorded over a four-year period, spanning the three years of residency and first year after graduation. These were analyzed by linear regression and t-tests. Residents also took surveys regarding research experience and chi squared tests and logistic regression were used to compare these results.

Results

The RR had 0.97 more publications and 1.3 more presentations compared to the CR after adjusting for PhD status, pre-residency publications and presentations, age at graduation, gender and race (p=0.09 and p=0.02, respectively). RR had higher odds of reporting adequate time to complete research (OR=13.11, 95% CI 3.58-48.03, p < 0.001) and satisfaction with their research experience (OR=6.96, 95% CI=2.104-23.053, p=0.002).

Conclusions

Residents with a research rotation had more time to complete research, were more satisfied with their research experience, and generated more publications and presentations compared to residents without the research rotation. A research rotation can help meet ACGME requirements and help residents achieve greater scholarly activity.

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.

Career Interests of Canadian Psychiatry Residents: What Makes Residents Choose a Research Career?

OBJECTIVES

Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research.

METHOD

Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents' future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest.

RESULTS

Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (χ2 = 0.007, df = 1, P = 0.93).

CONCLUSIONS

Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency.

Associations between resident physicians' publications and clinical performance during residency training

BACKGROUND

Both research and clinical medicine requires similar attributes of efficiency, diligence and effective teamwork. Furthermore, residents must succeed at scholarship and patient care to be competitive for fellowship training. It is unknown whether research productivity among residents is related to broad measures of clinical achievement. Our goal was to examine associations between the quantity of internal medicine residents' publications and validated measures of their knowledge, skills and multi-source evaluations of performance.

METHODS

This was a longitudinal study of 308 residents graduating from Mayo Clinic from 2006 to 2012. We identified peer-reviewed articles in Ovid MEDLINE between July of each resident's match year and the end of their graduation. Outcomes included American Board of Internal Medicine (ABIM) certification examination scores, mini clinical examination (mini-CEX) scores, and validated assessments of clinical performance by resident-peers, faculty and non-physicians. Performance assessments were averaged to form an overall score ranging from 1 to 5. Associations between quantity of resident publications--and ABIM, mini-CEX and performance assessment scores--were determined using multivariate linear regression.

RESULTS

The residents published 642 papers, of which 443 (69.0%) were research papers, 198 (30.8%) were case reports, and 380 (59.2%) were first-authored. On adjusted analysis, multi-source clinical performance evaluations were significantly associated (beta; 99% CI; p-value) with the numbers of research articles (0.012; 0.001-0.024; 0.007), and overall publications (0.012; 0.002-0.022; 0.002).

CONCLUSIONS

To our knowledge, this is the first study to demonstrate that scholarly productivity based on journal publication is associated with clinical performance during residency training. Our findings suggest that residents who invest substantial efforts in research are not compromised in their abilities to learn medicine and care for patients.

Effectiveness of iterative interventions to increase research productivity in one residency program

BACKGROUND

The Accreditation Council for Graduate Medical Education requires residency programs to expose residents to research opportunities.

OBJECTIVE

The purpose of this study was to assess the impact of a series of iterative interventions to increase scholarly activity in one internal medicine residency.

METHODS

Retrospective analysis of the effectiveness of a series of interventions to increase resident and faculty scholarly productivity over a 14-year period was performed using quality improvement methodology. Outcomes measured were accepted regional and national abstracts and PubMed indexed manuscripts of residents and faculty.

RESULTS

Initially, regional meeting abstracts increased and then were supplanted by national meeting abstracts. Sustained gains in manuscript productivity occurred in the eighth year of interventions, increasing from a baseline of 0.01 publications/FTE/year to 1.57 publications/FTE/year in the final year measured. Run chart analysis indicated special cause variation associated with the interventions performed.

CONCLUSIONS

Programs attempting to stimulate research production among faculty and residents can choose among many interventions cited in the literature. Since success of any group of interventions is likely additive and may take years to show benefit, measuring outcomes using quality improvement methodology may be an effective way to determine success.

Research training, productivity and challenges among trainees of pediatric residency programs across Saudi Arabia

Background and objectives

Research provides skills for lifelong learning and promotes patient care. In Saudi Arabia, until recently, research training has not been integrated effectively in postgraduate medical education. The aim of this study was to investigate the factors involved in research training, productivity, challenges, and attitude among trainees in pediatric residency programs across Saudi Arabia.

Materials and methods

This is a cross-sectional, multicenter study using a questionnaire designed to assess several aspects of research training among trainees of the national pediatric residency program in Saudi Arabia from September to December 2013.

Results

Eighty-three residents from seven training centers participated (response rate of 65.5%). Ninety percent of participants agreed that research training must be mandated in each residency program. The majority of participants (85.5–89.2%) agree that research is beneficial because it improves patient care, enhances the pursuit of academic careers, and improves fellowship acceptance rates and success. More than half (51.8%) of participants believe that research training will interfere with their efforts to become a medical expert in their fields. The survey indicated low research involvement by trainees, with 86.7% of participants having never published scientific manuscripts. The majority of participants (73.5%) reported a lack of regular, structured research activity in their training curriculum. The main challenge in research training was the lack of protected time (according to 86.7% of respondents). The majority of participants (85.6%) agreed that training in research methodologies represents their top educational need.

Conclusion

This study represents a “needs assessment” phase in the development of a research training curriculum for the Saudi pediatric residency program. The majority of participating residents have a positive attitude toward research. Research productivity and training were found to be low. A dedicated research curriculum within the residency program represents an effective and evidence-based solution.

Meeting Resident Scholarly Activity Requirements Through a Longitudinal Quality Improvement Curriculum

BACKGROUND

Quality improvement (QI) skills are learned during residency, yet there are few reports of the scholarly activity outcomes of a QI curriculum in a primary care program.

INTERVENTION

We examined whether scholarly activity can result from a longitudinal, experiential QI curriculum that involves residents, clinic staff, and faculty.

METHODS

The University of Pittsburgh Medical Center Shadyside Family Medicine Residency implemented a required longitudinal outpatient practice improvement rotation (LOPIR) curriculum in 2005. The rotation format includes weekly multidisciplinary work group meetings alternating with resident presentations delivered to the entire program. Residents present the results of a literature review and provide 2 interim project updates to the residency. A completed individual project is required for residency graduation, with project results presented at Residency Research Day. Scholarly activity outcomes of the curriculum were analyzed using descriptive statistics.

RESULTS

As of 2014, 60 residents completed 3 years of the LOPIR curriculum. All residents satisfied the 2014 Accreditation Council for Graduate Medical Education (ACGME) scholarly activity and QI requirements with a literature review presentation in postgraduate year 2, and the presentation of a completed QI project at Residency Research Day. Residents have delivered 83 local presentations, 13 state/regional presentations, and 2 national presentations. Residents received 7 awards for QI posters, as well as 3 grants totaling $21,639. The educational program required no additional curriculum time, few resources, and was acceptable to residents, faculty, and staff.

CONCLUSIONS

LOPIR is an effective way to meet and exceed the 2014 ACGME scholarly activity requirements for family medicine residents.

Implementing a resident research program to overcome barriers to resident research

Internal medicine residents are required to participate in scholarly activity, but conducting original research during residency is challenging. Following a poor Match at Baystate Medical Center, the authors implemented a resident research program to overcome known barriers to resident research. The multifaceted program addressed the following barriers: lack of interest, lack of time, insufficient technical support, and paucity of mentors. The program consisted of evidence-based medicine training to stimulate residents' interest in research and structural changes to support their conduct of research, including protected time for research during ambulatory blocks, a research assistant to help with tasks such as institutional review board applications and data entry, a research nurse to help with data collection, easily accessible biostatistical support, and a resident research director to provide mentorship. Following implementation in the fall of 2005, there was a steady rise in the number of resident presentations at national meetings, then in the number of resident publications. From 2001 to 2006, the department saw 3 resident publications. From 2006 to 2012, that number increased to 39 (P< .001). The department also saw more original research (29 publications) and resident first authors (12 publications) after program implementation. The percentage of residents accepted into fellowships rose from 33% before program implementation to 49% after (P = .04). This comprehensive resident research program, which focused on evidence-based medicine and was tailored to overcome specific barriers, led to a significant increase in the number of resident Medline publications and improved the reputation of the residency program.