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

The Undermined ACGME Subcompetency: A Roadmap for Radiology Residency Programs to Foster Residents-as-Educators

Radiology Residency programs in the United States use a set of six core competencies as laid out by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate the foundational skills of every resident. Despite the fact that educational skills are included under the heading of Practice-Based Learning and Improvement in the ACGME guidelines for radiology residents, it is often underappreciated and undervalued, when compared with medical knowledge or patient care. In this paper, the authors lay out the important role of residents-as-educators and how it can be inculcated as part of formal training during residency. They enunciate five pillars for academic programs to build and maintain the pedagogical skills of their radiology residents: Training, Practicing, Providing Feedback, Mentoring, and Changing the Culture. The authors believe that implementing this will holistically benefit radiology residents as well as radiology in building future educators. The authors also delineate the challenges that programs currently face in implementation and ways to overcome them.

Characteristics of highly prolific PA authors who contributed research to JAAPA and JPAE

OBJECTIVE

Highly published physician associate/assistant (PA) researchers were surveyed to quantify experienced support patterns that may inform increased support of PA-led research.

METHODS

Publication volume of authors of research articles published in JAAPA and the Journal of Physician Assistant Education (JPAE) between 2011 and 2020 was recorded. PAs in the upper quartile were emailed surveys containing demographics and 25 Likert-scale questions. Descriptive statistics and binomial exact test were completed.

RESULTS

Sixty-five of the 73 PAs were contacted by email; 26 participated; and 35% were female. Social support measures were high; respondents were mentors and mentees, who work collaboratively. Material support and educational support measures were lower and most reported no funding nor pay for research; they did not learn research skills in PA school. However, they feel recognized, and find joy in research.

CONCLUSIONS

Successful PA researchers find joy despite low material support regarding funding, pay, and protected time. Women and racial minorities were underrepresented; research is needed to examine potential barriers.

The content expert program: A structured approach to increase emergency medicine resident scholarly activity

Objectives

The Accreditation Council for Graduate Medical Education requires residents to participate in scholarship and requires residency programs to provide an environment within which residents can acquire skills related to scholarly activities. However, consensus on the definition of scholarship and structure of program environments does not yet exist. We designed and implemented a content expert program (CEP) in 2015, in which each resident worked with a faculty advisor to develop a longitudinal scholarly activity linked to a core area of practice and, in doing so, became the department's "content expert." We hypothesized that the CEP would significantly increase the number of scholarly outputs per resident.

Methods

The CEP was structured around an oversight committee composed of key faculty members, which guided development of CEP projects through regular meetings and formative feedback. Each resident generated one or more scholarly outputs from their content area. Outputs were categorized into educational, operational, research, and miscellaneous domains and further identified as intradepartmental, interdepartmental, or interdisciplinary collaborations. The number of outputs was compared to the baseline number of scholarly activities per resident at the study program using a Mann-Whitney U test.

Results

A total of 187 scholarly outputs were generated by 76 residents, which equated to 31.2 outputs per year, or 2.5 outputs per resident. This was a significant increase compared to the program baseline of one output per resident (p = 0.003). Eighteen distinct types of outputs spanned four major categories. Of the outputs, 37 were interdepartmental, 42 were interdisciplinary, and 32 were intradepartmental.

Conclusions

The CEP proved to be a sustainable way to significantly increase scholarly activity and additionally improved collaborative efforts. With the appropriate structure and willing faculty in place, such a program can enhance the practical education provided by residency programs.

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.

Benefits of developing graduate medical education programs in community health systems

The creation of new CMS-funded Graduate Medical Education (GME) cap positions by the Consolidated Appropriations Act 2021 offers a unique opportunity for systems in community and rural settings to develop and expand their training programs. This article provides a review of the evidence behind the value proposition for system administrators to foster the growth of GME in community health systems. The infrastructure needed to accredit GME programs may reduce the cost of care for both the patients and the system through improved patient outcomes and facilitation of system efforts to recognize and mitigate social determinants of health. Residents, fellows and medical students expand the capacity of the current healthcare workforce of a system by providing coverage during healthcare emergencies and staffing services in difficult-to-recruit specialties. Those trainees are the nucleus of succession planning for the current medical staff, can facilitate the creation and expansion of service lines, and may elevate the profile of the system through scholarly work and equity and quality improvement activities. While creating GME programs in a community health system may, at first glance, be perceived as cost-prohibitive, there are robust advantages to a system for their creation.

The Effect of a Points System on Incentivizing Academic Behaviors of Attending Ophthalmologists

(1) Background: Little is known regarding the best ways to promote academic throughput within the ranks of attending ophthalmology physicians. The purpose of this project is to evaluate the effect of a monetized points system on incentivizing research output and other academic activity in academic ophthalmology attendings. (2) Methods: This is a retrospective study of 15 academic ophthalmology attendings at a single academic teaching hospital from 1 July 2015 to 30 June 2020. A points system was implemented in the 2017 academic year (1 July 2016–30 June 2017), in which ophthalmology attendings accrued points for eight categories of academic achievement. We compared the overall number of publications, number of first/senior author publications, and corresponding impact factors of journals via the PubMed database in the two years of data before and after the points system was implemented. We analyzed points awarded for eight categories of academic achievement in the first, second, and third year of the program. (3) Results: There was no significant change in research productivity for attending ophthalmologists after institution of the points system. From 2017 to 2019, Mann–Whitney analysis revealed a significant increase in points awarded for mentorship per physician (p = 0.013). (4) Conclusions: Our data suggest that within the framework of the points system, attendings—rather than prioritizing publications—gravitated towards mentorship activities to accrue points.

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).

The Positive Effect of Monetary Incentive on Urology Resident Research

OBJECTIVE

To evaluate whether a financial incentive changed research patterns among residents over a 12-year period.

METHODS

At our institution, beginning July 2016, any resident work that led to a PubMed citation was awarded $1,000. A review of the PubMed database and the regional meeting of the South Central Section of AUA (SCS/AUA) presentation itineraries were used to quantify and qualify the participation in research by these residents before and after introduction of the financial incentive.

RESULTS

Scholarly activity from thirty out of thirty possible residents was evaluated. The monetary incentive resulted in increased production post-incentive (6.33) vs pre-incentive (2.44) in average total authorship participation published to PubMed per year (P = .0125). The average number of PubMed primary authorships per resident per year increased from 0 in July 2007-June 2008 to 0.7 in July 2018-June 2019, displaying upward trajectory. Average primary authorship of research produced per year presented at SCS/AUA and published to PubMed increased postincentive (9.00) vs pre-incentive (4.89) (P = .0479). More review articles and less basic science research were published after the incentive.

CONCLUSION

Offering financial incentives to urology residents increased publications and meaningful participation in research.

Evaluating the potential merger of two internal medicine residency programs: process and recommendations

Background: Economic forces have led to significant consolidation within the health-care sector, but the effects of hospital mergers on graduate medical education programs are not well studied. Academic leaders may be expected to operationalize an institutional merger through educational program consolidation. Through a case study of our potential GME program consolidation, the authors present a helpful model for assessing the practicality of a program consolidation and share lessons learned.

Methods: A novel exploratory process assessed the viability of four levels of integration for two internal medicine programs within a merged health system. Focused interviews with outside organizations, literature review, SWOT analysis by stakeholders, and a semi-quantitative scoring system resulted in the final recommendation to health system administration.

Results: The two internal medicine programs will pursue educational and administrative synergies but will not merge.

Discussion: Common challenges facing GME leadership in assessing the viability of a merger include: different organizational culture, mistrust of intentions, lack of a shared vision, lack of communication, and managing the pace of change to prevent erosion of the learning environment. Overcoming these challenges is best accomplished by establishing shared values, recognizing synergies and estimating organizational compatibility. Maximizing faculty and resident interactions while performing combined QI projects, research, or didactics can build trust over time and change the cultural norm. Early successes are vital to the process. Finally, even if residency programs do not merge, they should have common salaries and benefits so that disparities do not engender further distrust.

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.

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.

Otolaryngology Residency Program Research Resources and Scholarly Productivity

Objective To delineate research resources available to otolaryngology residents and their impact on scholarly productivity. Study Design Survey of current otolaryngology program directors. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. Results Thirty-nine percent (n = 38) of queried programs responded. Fourteen (37%) programs had 11 to 15 full-time, academic faculty associated with the residency program. Twenty (53%) programs have a dedicated research coordinator. Basic science lab space and financial resources for statistical work were present at 22 programs (58%). Funding is uniformly provided for presentation of research at conferences; a minority of programs (13%) only funded podium presentations. Twenty-four (63%) have resident research requirements beyond the Accreditation Council for Graduate Medical Education (ACGME) mandate of preparing a "manuscript suitable for publication" prior to graduation. Twenty-five (67%) programs have residents with 2 to 3 active research projects at any given time. None of the investigated resources were significantly associated with increased scholarly output. There was no uniformity to research curricula. Conclusions Otolaryngology residency programs value research, evidenced by financial support provided and requirements beyond the ACGME minimum. Additional resources were not statistically related to an increase in resident research productivity, although they may contribute positively to the overall research experience during training. Potential future areas to examine include research curricula best practices, how to develop meaningful mentorship and resource allocation that inspires continued research interest, and intellectual stimulation.