Addressing research barriers and facilitators in medical residency

Barriers Preventing Medical Trainees from Active Participation in Research Activities

Background

Research has increasingly become important to career progression and a compulsory component in most medical programs. While medical trainees are consistently urged to undertake research endeavors, they frequently encounter obstacles at both personal and organizational levels that impede the pursuit of high-quality research. This study aims to identify the barriers and recommend successful interventions to increase research productivity amongst medical trainees.

Methods

A descriptive cross-sectional survey was carried out among interns, residents, and fellows within a single hospital located in the emirate of Abu Dhabi, UAE. The survey included inquiries regarding perceived obstacles hindering engagement in research activities, factors driving motivation for research involvement, and the assessment of how research participation relates to their job in terms of relevance.

Results

Fifty-seven medical trainees participated in the survey, reflecting a response rate of 53%. The survey highlighted common obstacles, notably including time constraints, insufficient statistical and methodology training, the weight of other educational commitments, as well as inadequate incentives and rewards. While a majority of participants expressed interest in engaging in research activities, the consensus was that more incentives and increased funding opportunities would significantly encourage their involvement.

Conclusion

Implementing successful interventions such as allocating dedicated time for research, facilitating access to research mentors, and organizing training sessions have the potential to be effective strategies in fostering a thriving research culture and subsequently elevating research productivity of medical trainees.

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.

World Workshop on Oral Medicine VIII: Barriers to research in oral medicine: results from a global survey

OBJECTIVES

To explore factors influencing research interest and productivity and perceived barriers to conducting research in Oral Medicine (OM).

METHODS

Invitations to participate in an online survey were e-mailed to a network of international OM practitioners and related professional organizations. Questions captured respondents' demographic/professional variables and gauged research interest, productivity, and perceived barriers to conducting research specifically in OM. Statistical analysis was conducted via descriptive, logistic regression, and multivariate modeling.

RESULTS

Five hundred and ninety-three OM practitioners from 55 countries completed the survey, with 54%, 25%, and 21% practicing in high, upper-middle, and lower-middle-income countries, respectively. Eighty-six percent of respondents were interested in conducting research. Age (less interest with an increase in age), working in academia, and practicing in a lower-middle vs high-income country were significant predictors of research interest. Self-reported research productivity was significantly greater among males, those working in academia, and those who graduated from programs that mandated research presentation/publication. Obtaining research funding was a significant barrier among respondents from lower and upper-middle-income countries, whereas finding time for research was a reported barrier by respondents from high-income countries.

CONCLUSION

The results of this survey identified perceived barriers to conducting research in OM and highlighted solutions to address such barriers.

The Development of a Clinical Research Model Complementing Medical Residency and the Assessment of Research Productivity

BACKGROUND AND OBJECTIVE

Despite modern healthcare infrastructure, there is a paucity of information about the clinical research framework supporting healthcare in the United Arab Emirates (UAE). Therefore, this study aimed to assess research performance productivity, and the clinical research framework, complementing medical residency, at the nation's hub for clinical research.

METHODS

A cross-sectional retrospective review of records from the research database of the institution was conducted to assess productivity, and framework development, and data analyzed.

RESULTS

 The migration of global healthcare providers, and the pharmaceutical industry offices, the adoption of the International Conference on Harmonization (ICH) guidelines, and electronic medical records established a research culture. Following the development of the governance framework, a total of 1,328 research projects were submitted to the ethics committee until 2023. Approximately 63% of the total studies were of minimal risk, followed by industry-sponsored clinical trials (4.9%, 58/1,163), and prospective interventional studies (3.5%, 39/1,163). Almost half (48.3%, 28/58) of the total industry-sponsored clinical trials were phase II and phase III. The number of peer-reviewed indexed publications, a measure of research productivity, indicated that the periods between 2011 and 2015, 2016 and 2020, and 2021 and 2023 witnessed a 3.8-, 9.3-, and 7.9-fold increase compared to the baseline period (1995-2005). The implementation of the Focus on International Research Strategy, Teaching, Evaluation, and Mentoring (FIRSTEM) strategy, to accommodate mandatory research activity requirements for residents by the physician licensing boards, observed substantial increases in output. The number of international peer-reviewed indexed publications/resident projects doubled from 10.8% (2010-2015) to 24% (2016-2020) and reached 40.1% in 2023.

CONCLUSION

This is the first research governance model established in the UAE, a country with an increasing prevalence of diabetes, and cardiovascular and genetic diseases. The model indicates that the medical trainees differentiate the best research evidence in making decisions about the clinical care of patients. The study outcomes may potentially be useful for other countries in developing a clinical research framework.

Medical Resident Awareness of Predatory Journal Practices in an International Medical Education System

INTRODUCTION

Learning research methodology is increasingly becoming an essential part of graduate medical education worldwide, with many regulatory and accreditation bodies requiring residents to participate in scholarship. Research methodology workshops have become a standard part of medical curricula; however, there is limited data on how much training on journal selection and the publication process trainees receive. The alarming growth of predatory journals has made it increasingly difficult for researchers, especially trainees and early career physicians, to distinguish these publications from reputable journals. The purpose of this study is to assess the knowledge of reputable and predatory publishing practices amongst medical trainees in an international medical education setting in the United Arab Emirates.

METHODS

A survey on credible journal practices based on the 'Think. Check. Submit' initiative was sent to all graduate medical education trainees at two large academic medical centers in Abu Dhabi, United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies.

RESULTS

Over half of the 160 respondents reported receiving prior research methodology training and 42.5% had at least one publication. The majority of the trainees selected impact factor and the quality of the peer-review process as characteristics of reputable journals. Ambiguous editorial board and rapid publication process were recognized as characteristics of predatory journals by >65% of trainees, however, 95% of all trainees were unaware of Beall's list or other resources to help select a journal for publication. 15.2% of trainees who received unsolicited emails from publishers submitted their manuscripts to the unfamiliar journals, citing peer recommendation and pressure to publish from their training programs as reasons.

CONCLUSION

Trainees in the United Arab Emirates were mostly unaware of reputable publication practices and are vulnerable to publishing in predatory journals. Policy and educational reform are necessary to maintain the credibility and integrity of the scientific process.

Learning to SuRRF: Sustained Engagement and Increased Academic Productivity Over Two Years of a Resident-Led Virtual Laboratory

OBJECTIVE

To determine if implementation of a resident-led virtual laboratory can sustain increased engagement and academic productivity in residents and faculty.

DESIGN

We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. SuRRF utilizes monthly virtual lab meetings, weekly newsletters, a centralized database of projects, project tracking tools, and a shared calendar of deadlines to facilitate research among surgical residents. Data on number of participating residents, faculty, and projects across SuRRF meetings at 1-year (7/2020) and 2-years post-implementation (9/2021) were collected to evaluate engagement. Institutional ACGME Resident Scholarly Activity and Faculty Scholarly Activity reports were evaluated for the pre-SuRRF implementation (2018-2019) and post-implementation (2020-2021) academic years to assess productivity pre- and post-implementation.

SETTING

Three tertiary academic hospitals of a single health system in New York.

PARTICIPANTS

All residents in our general surgery program during the study period, including research residents, were eligible to participate in our study.

RESULTS

At 1-year, there were 2 attendings, 13 residents, and 23 projects, compared to 12 attendings, 25 residents, and 42 projects at 2-years post-implementation. Post-SuRRF implementation, residents had significantly more publications (0.56 ± 0.15 vs. 1.10 ± 0.15, p = 0.005), textbook chapters (0.00 vs. 0.010 ± 0.044, p = 0.014), research participation (p < 0.01), and scholarly activity (p = 0.02). Post-SuRRF, faculty had significantly more publications (0.74 ± 0.15 vs. 2.20 ± 0.33, p < 0.001) and scholarly activity (p = 0.006).

CONCLUSIONS

SuRRF promotes exposure to projects and resources and increases collaboration and peer-to-peer mentorship. Our experience with SuRRF suggests that resident-led virtual laboratories may increase peer-reviewed publications and improve resident and faculty engagement in scholarly activity, thus supporting academic growth.

An analysis of the selection criteria for postgraduate physician assistant residency and fellowship programs in the United States

BACKGROUND

This study aims to investigate the admission criteria used by physician assistant postgraduate education programs in selecting licensed PA applicants for postgraduate training in the United States. To our knowledge, there have been no previously published reports on selection criteria and/or other factors influencing postgraduate PA admission decisions.

METHOD

A non-experimental, descriptive research study was designed to obtain information from members of the Association of Postgraduate Physician Assistant Programs (APPAP).

RESULTS

Twenty-three out of 73 postgraduate programs (35%) responded to the survey. The study reported that applicant PAs and NPs are largely selected on the basis of several factors. The most heavily weighted factor is the interview itself; other selection criteria perceived to be extremely/very important included board certification/eligibility, letters of recommendation, advanced degree, and personal essay. Survey data suggest that publications, undergraduate transcripts, and class rankings are not considered to be of high importance in applicant selection. The number of PA applicants applying to each postgraduate training program averages around 26 and total number of enrollees is about 3.6 per program. Additionally, some programs reported furloughing of trainees (temporary suspension of didactic and clinical training) during the pandemic, whereas the vast majority of postgraduate PA programs remained operational and some even experienced an increase in application volume. The total cost of training a PA resident or fellow in postgraduate programs is currently $93,000 whereas the average cost of training a categorical physician resident is estimated at $150,000 per year when considering both salary and benefits.

CONCLUSIONS

This novel study examined criteria and other factors used by postgraduate PA programs in selecting candidates for admission. Results can be used by postgraduate programs to improve or modify current selection criteria to enhance the quality of trainee selection. Further research is needed to examine correlations between applicant attributes, selection criteria, and trainee success in completing postgraduate training.

Diving Under the SuRRFace: Achieving More Than Just Compliance with ACGME Scholarly Activity Mandate

OBJECTIVE

To determine if building a digital technology supported infrastructure improves general surgery residents' confidence to conduct clinical research.

DESIGN

We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. An anonymized survey asked residents to rate their confidence using a five-point Likert scale in various fields pre- and post-intervention. Fields included: finding a research mentor, developing a project, conducting research, performing an effective literature search, navigating internal and external resources, and ability to complete a research project.

SETTING

Northwell Health - North Shore University Hospital / Long Island Jewish Medical Center: academic tertiary care centers.

PARTICIPANTS

All 58 residents in our general surgery program, including research residents, were eligible to participate in our study.

RESULTS

Survey response rate was 55% (28 clinical residents, 4 research fellows). Post-implementation of SuRRF, all respondents (PGY1-5) reported an increase in awareness of abstract/conferences submission deadlines (2.34 ± 1.1 pre- vs. 3.75 ± 1.1 post-implementation, p = 0.004) and ability to navigate institutional electronic medical information library resources (2.2 ± 1.0 pre- vs. 3.62 ± 1.2 post-implementation, p = 0.000). Junior residents (PGY1-3) had improvement in all areas except for finding a mentor and improving their confidence with literature review.

CONCLUSIONS

Creation of a resident-led virtual laboratory infrastructure increases participation, improves perception of research abilities, and improves attitudes towards performing clinical research among general surgery residents. Future research will follow the impact of this virtual laboratory on publications and grants.

How and why do French medical students choose the specialty of infectious and tropical diseases? A national cross-sectional study

BACKGROUND

Infectious and tropical diseases (ID) physicians are needed now more than ever to tackle existing and emerging global threats. However, in many countries, ID is not recognized as a qualifying specialty. The creation of ID residency in 2017 in France offers the opportunity to know how and why the specialty is chosen by medical students.

METHODS

We first analyzed the choice of specialty of all French medical students in 2017 and 2018 according to their rank at the national exam that ends medical studies. A web questionnaire was then sent in January 2019 to all ID residents in France (n = 100) to assess the factors influencing their choice of specialty and their career plan.

RESULTS

We analyzed the choice of 17,087 medical students. ID was the first-chosen specialty with a median national rank of 526/8539, followed by plastic surgery and ophthalmology. The questionnaire was completed by 90% of the French ID residents (n = 100). The most encouraging factors to choose ID were the multi-system approach of the specialty, the importance of diagnostic medicine and having done an internship in ID during medical school. The potential deterrents were the work-life balance, the workload and the salary.

CONCLUSIONS

The recent recognition of ID as a qualifying specialty in France can be considered a success insofar as the specialty is the most popular among all medical and surgical specialties. Individuals who choose ID are attracted by the intellectual stimulation of the specialty but express concerns about the working conditions and salaries.

An analysis of cross-continental scholarship requirements during neurosurgical training and national research productivity

OBJECTIVE

Engagement in research and scholarship is considered a hallmark of neurosurgical training. However, the participation of neurosurgical trainees in this experience has only recently been analyzed and described in the United States, with little, if any, data available regarding the research environment in neurosurgical training programs across the globe. Here, the authors set out to identify requirements for research involvement and to quantify publication rates in leading neurosurgical journals throughout various nations across the globe.

METHODS

The first aim was to identify the research requirements set by relevant program-accrediting and/or board-certifying agencies via query of the literature and published guidelines. For the second part of the study, the authors attempted to determine each country's neurosurgical research productivity by quantifying publications in the various large international neurosurgical journals-World Neurosurgery, Journal of Neurosurgery, and Neurosurgery-via a structured search of PubMed.

RESULTS

Data on neurosurgical training requirements addressing research were available for 54 (28.1%) of 192 countries. Specific research requirements were identified for 39 countries, partial requirements for 8, and no requirements for 7. Surprisingly, the authors observed a trend of increased average research productivity with the absence of designated research requirements, although this finding is not unprecedented in the literature.

CONCLUSIONS

A variety of countries of various sizes and neurosurgical workforce densities across the globe have instituted research requirements during training and/or prior to board certification in neurosurgery. These requirements range in intensity from 1 publication or presentation to the completion of a thesis or dissertation and occur at various time points throughout training. While these requirements do not correlate directly to national research productivity, they may provide a foundation for developing countries to establish a culture of excellence in research.

Assessing the Clinical Learning Environment in an Institution in the United Arab Emirates: The Resident Perspective

BACKGROUND

A new accreditation model in the United States has increased focus on the clinical learning environment (CLE). There is limited research on trainee perceptions of the CLE in international settings.

OBJECTIVE

We surveyed residents to obtain their perspective on the CLE at 1 sponsoring institution in the United Arab Emirates (UAE).

METHODS

We surveyed residents at Tawam Hospital, UAE, a sponsoring institution with 142 trainees, on their perspectives in the 6 focal areas of the US Clinical Learning Environment Review (CLER) to gather baseline information. We administered a 26-item questionnaire to residents through an audience response system in November 2018.

RESULTS

Of 100 residents in postgraduate year 2 and above, 72 (72%) responded. The perspective of the majority of respondents was favorable in the areas of reporting patient safety incidents, engaging in quality improvement activities, using a standardized form for care transition, and using professional guidelines for electronic health record documentation. In contrast, only half of the respondents perceived there is honesty in the reporting of duty hours, and only 36% felt the organization supported fatigue management. Other areas for improvement included residents' understanding of the concept of health disparities and activities to address health disparities.

CONCLUSIONS

Our findings suggest that in key focal areas related to patient safety, health care quality, care transitions, and professionalism, UAE residents have similar perceptions of their CLE as US trainees. Opportunities for improvement include duty hour reporting, fatigue mitigation, and addressing health disparities.