The PRIME curriculum. Clinical research training during residency

An Evaluation of Research Publications for General Surgery Residents And its Influence on the Future Pursuit of Fellowship or Academic Career

INTRODUCTION

Traditionally, the Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to implement research and other scholarly activities into their training curriculum. Encouraging residents to publish during residency is believed to promote research throughout their careers; however, the rate of research outcomes among general surgery residents remains unknown. Our study aims to determine associated factors that influence publication rates before, during, and after general surgery residency.

METHODS

This observational study employed a cross-sectional design. We examined whether research outcomes during general surgery residency was associated with academic advancement or continued research involvement after residency. We identified 321 general surgery residency programs on the Doximity website and randomly selected 50 to include in our sample. Of these programs, graduate rosters for 31 programs were located and subsequently included. Of the 405 residency graduates identified, we recorded the number of peer-reviewed publications, H-indices, fellowships, and whether the graduate pursued a career in private practice or academia.

RESULTS

Among the 405 physicians analyzed, 3815 total publications were identified with a mean of 9.4 (SD 11.8) per person. The most reported study design was observational studies (46.5%; 1775/3815) and the least reported was systematic reviews/meta-analyses (1.4%; 52/3815). The number of publications before residency positively correlated with having a higher h-index (r = 0.4). We also found that physicians who completed a fellowship had more publications during residency (mean = 4.7, SD = 6.5) than those not pursuing a fellowship (mean = 1.5, SD = 2.7; t= -4.3. p ≤ 0.001). We observed a statistically significant increase in the likelihood a physician pursued a career in academic medicine if they pursued a fellowship (OR: 3.77, 95% CI: 2.0-7.2) and if they had published research as a primary author (OR 1.25, 95% CI: 1.0-1.5).

CONCLUSION

Increased research productivity was associated with continued academic pursuits and an increased likelihood of pursuing fellowship training after residency.

Strengthening the clinical academic pathway: a systematic review of interventions to support clinical academic careers for doctors and dentists

OBJECTIVE

Evaluate existing evidence on interventions intended to increase recruitment, retention and career progression within clinical academic (CA) careers, including a focus on addressing inequalities.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, Cochrane Controlled Register of Trials, PsycINFO and Education Resource Information Center searched October 2019.

STUDY SELECTION

Eligible studies included qualified doctors, dentists and/or those with a supervisory role. Outcomes were defined by studies and related to success rates of joining or continuing within a CA career.

DATA EXTRACTION AND SYNTHESIS

Abstract screening was supported by machine learning software. Full-text screening was performed in duplicate, and study quality was assessed. Narrative synthesis of quantitative data was performed. Qualitative data were thematically analysed.

RESULTS

148 studies examined interventions; of which 28 were included in the quantitative synthesis, 17 in the qualitative synthesis and 2 in both. Studies lacked methodological rigour and/or were hindered by incomplete reporting. Most were from North America. No study included in the syntheses evaluated interventions aimed at CA dentists.Most quantitative evidence was from multifaceted training programmes. These may increase recruitment, but findings were less clear for retention and other outcomes. Qualitative studies reported benefits of supportive relationships, including peers and senior mentors. Protected time for research helped manage competing demands on CAs. Committed and experienced staff were seen as key facilitators of programme success. Respondents identified several other factors at a programme, organisational or national level which acted as facilitators or barriers to success. Few studies reported on the effects of interventions specific to women or minority groups.

CONCLUSIONS

Existing research is limited by rigour and reporting. Better evaluation of future interventions, particularly those intended to address inequalities, is required. Within the limits of the evidence, comprehensive multifaceted programmes of training, including protected time, relational and support aspects, appear most successful in promoting CA careers.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework: https://osf.io/mfy7a.

Curricula, Teaching Methods, and Success Metrics of Clinician-Scientist Training Programs: A Scoping Review

PURPOSE

To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models.

METHOD

The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics.

RESULTS

From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment).

CONCLUSIONS

Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.

Addressing Motivations and Barriers to Research Involvement during Medical School among Osteopathic Medical Students in the United States

Involvement in research is regarded as a high-impact educational practice, which, for medical professionals, is associated with sharpened critical thinking and life-long learning skills, greater appreciation for evidence-based medicine, and better clinical competence scores. However, there are limited data regarding the research experience and/or interest among osteopathic medical students in the United States despite a rapidly increasing enrollment and expansion of the number of osteopathic medical schools. Thus, we administered an electronic survey examining prior research experience, interests, and perceptions about research participation during medical school to four successive classes of incoming first-year osteopathic medical students. We also performed focus groups with rising third-year osteopathic medical students around the topic of perceived barriers to and potential enablers of promoting research participation. This yielded a survey addendum where first-year osteopathic medical students provided feedback on the likelihood of specific incentives/enablers to encourage participation in research during medical school. Overall, osteopathic medical students are interested in research, view research experience as valuable, and perceive research experience as beneficial to future career development. Students perceive that the primary barrier to involvement in research is a potential negative impact upon performance in coursework. Feedback on the likelihood of specific enablers/incentives was also garnered. Our findings from a single institution may have important implications in defining the prior experiences and perceptions held by first-year osteopathic medical students. Specifically, our study indicates that research experiences intentionally designed with (1) a strong likelihood of gaining a publication, (2) financial compensation, and (3) the opportunity for short-term involvement, a flexible time commitment, and/or a dedicated time period are most likely to encourage research participation by osteopathic medical students.

Experience, Attitude, and Perceived Barriers Toward Research Among Ophthalmology Residents in Saudi Arabia: A National Cross-Sectional Study

Introduction

Research sets the foundation for evidence-based practice in medicine. Globally resident doctors in various specialties are facing major obstacles to accomplish high quality research projects. Understanding these obstacles may help residents achieve their maximum research potential. This current study was undertaken to document the experience, attitude, and perceived barriers toward research among Saudi ophthalmology residents.

Methodology

A specific questionnaire was developed and validated for the purpose of this study. The questionnaire was distributed online via email to actively enrolled residents in all five ophthalmology training programs in Saudi Arabia.

Results

Out of a total number of 193 ophthalmology residents in all five training programs, 147 responded to the questionnaire yielding a 76.1% response rate the mean age of participants was 27.6 ±1.8 and the number of males and females was almost equal. The vast majority [96.4%] have worked on at least one research project before starting residency training. Involvement was mainly in the phases of concept and design [72.5%], proposal preparation [85.9%], the three most frequent obstacles to conducting research projects for trainees were burden of other activities [4.27], lack of protected time for research [4.11] and too many regulations in obtaining ethical approval [3.67].

Discussion

Our current study shows that ophthalmology residents understand the importance of clinical research, but they are facing a considerable number of barriers toward accomplishing high-quality research projects. Findings of our study may help program directors to address these barriers and improve the incorporation of research along with clinical training in residency curricula.

Publication Trends and Their Relationship With Academic Success Among Dermatology Residents: Cross-sectional Analysis

BACKGROUND

Involvement in scholarly activities is considered to be one of the foundational pillars of medical education.

OBJECTIVE

This study aims to investigate publication rates before, during, and after residency to determine whether research productivity throughout medical training correlates with future academic success and research involvement.

METHODS

We successfully identified a list of 296 graduates from 25 US dermatology residency programs from the years 2013-2015. The publication history for each graduate was compiled using Scopus, PubMed, and Google Scholar. The Pearson correlation test and linear regression were used to assess the relationship between research productivity and continued academic success after residency graduation.

RESULTS

Before residency, graduates published a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates published a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications. Graduates who pursued a fellowship had more total publications (t294=-4.0; P<.001), more first-author publications (t294=-3.9; P<.001), and a higher h-index (t294=-3.8; P=.002). Graduates who chose to pursue careers in academic medicine had more mean total publications (t294=-7.5; P<.001), more first-author publications (t294=-5.9; P<.001), and a higher mean h-index (t294=-6.9; P<.001). Graduates with one or more first-author publications before residency were 1.3 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.3, 95% CI 1.1-1.5). Graduates who pursued a fellowship were also 1.9 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.9, 95% CI 1.2-3.2).

CONCLUSIONS

Our results suggest that research productivity before and during residency training are potential markers for continued academic success and research involvement after completing dermatology residency training.

Evidence-based medicine curricula and barriers for physicians in training: a scoping review

OBJECTIVES

To describe the published literature on EBM curricula for physicians in training and barriers during curriculum implementation.

METHODS

We performed a systematic search and review of the medical literature on PubMed, Embase, ERIC, Scopus and Web of Science from the earliest available date until September 4, 2019.

RESULTS

We screened 9,042 references and included 29 full-text studies and 14 meeting abstracts. Eighteen studies had moderate validity, and 6 had high validity. The EBM curricular structure proved highly variable in between studies. The majority of the EBM curricula was longitudinal with different lengths. Only five studies reported using Kern's six-step approach for curriculum development. Twenty-one articles reported on EBM skills and knowledge, and only 5/29 full-text articles used a validated assessment tool. Time was the main barrier to EBM curriculum implementation. All the included studies and abstracts, independent of the EBM curriculum structure or evaluation method used, found an improvement in the residents' attitudes and/or EBM skills and knowledge.

CONCLUSIONS

The current body of literature available to guide educators in EBM curriculum development is enough to constitute a strong scaffold for developing any EBM curriculum. Given the amount of time and resources needed to develop and implement an EBM curriculum, it is very important to follow the curriculum development steps and use validated assessment tools.

Assessment of the Research Interests and Perceptions of First-Year Medical Students at 4 Colleges of Osteopathic Medicine

Context

There are limited data regarding the experiences of and attitudes toward research participation among osteopathic medical students despite rapidly increasing enrollment and expansion of the number of osteopathic medical schools.

Objective

To assess first-year osteopathic medical students' experience with research, their interest in it, their perceptions of its value, and barriers to participation.

Methods

An anonymous, online survey was sent to 868 medical students in the class of 2021 at 4 colleges of osteopathic medicine. The survey consisted of 14 multiple-choice items (7 of which offered the option of a written response) and 1 open-ended item that asked them to report their age. The survey remained open for 2 weeks, with 1 reminder email sent on the last day of the survey. Incomplete responses were excluded from the analysis.

Results

A total of 328 participants were included, for a response rate of 38%. A majority of respondents reported previous research experience (261 [79.6%]), consistent with a strong perception that research participation is important (315 [96.0%]). Fewer students (177 [54.0%]) were either currently participating in research or affirmed interest in performing research during medical school, with the highest level of interest in clinical research (259 [79.0%]) followed by basic science (166 [50.6%]). Regarding incentives that might encourage participation in research, students preferred monetary compensation (213 [64.9%]) or extra credit in courses (195 [59.5%]). A commonly reported barrier to performing research during medical school was the possibility of a negative impact on performance in coursework (289 [88.1%]).

Conclusion

First-year osteopathic medical students are interested in research, view research experience as valuable, and consider research experience as beneficial to future career development. This study's findings highlight opportunities for increasing student participation in research through incentives or removal of perceived barriers.

Pulmonary arterial capacitance predicts outcomes in patients with pulmonary hypertension independent of race/ethnicity, sex, and etiology

BACKGROUND

Pulmonary arterial capacitance (PAC) is a strong hemodynamic predictor of outcomes in patients with pulmonary hypertension (PH). Its value across subgroups of race/ethnicity, sex, and PH etiologies is unclear. We hypothesized that the association of PAC with outcomes would not vary across World Health Organization (WHO) PH group, race/ethnicity, or sex.

METHODS

We performed a retrospective study in patients with PH diagnosed and managed at the Pulmonary Hypertension Comprehensive Care Center of a tertiary care hospital (n = 270). Demographic, diagnostic, treatment, and outcome data were extracted from the electronic medical record. Cox proportional hazards models were used to model time from right heart catheterization to event in univariate and multivariable models. Our primary outcome was all-cause mortality and our secondary outcome was PH hospitalization.

RESULTS

The median age of the cohort was 56 years (±14.6), and 67% were female. In multivariable Cox models adjusted for significant covariates, decreased PAC remained independently and significantly associated with both all-cause mortality (p = 0.029) and hospitalization for PH (p = 0.010). No significant interactions were observed between PAC and race, sex, or WHO group. Hispanic patients exhibited a significant independent association with increased hospitalizations (p = 0.030), and there was a trend toward increased all-cause mortality in African Americans. WHO group 2 PH was associated with more frequent hospitalization (p = 0.004).

CONCLUSIONS

Decreased PAC is significantly associated with mortality and hospitalization in PH patients independent of race, sex, and PH subgroups. Further investigation is required to characterize the effects and determinants of racial disparities in PH.

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.

Addressing research barriers and facilitators in medical residency

Objective:

To develop and implement an instrument to identify contributing factors and obstacles to resident research participation.

Materials and Methods:

Clinical Research Excellence Development in Innovation and Technology (CREDIT-20), a 20-point questionnaire, was developed through a four-stage methodology to measure opportunities and challenges to enhance participation of medical residents in research. The study was distributed to all medical residents at three Joint Commission–accredited academic medical centers in the emirate of Abu Dhabi between March 2017 and July 2018. Participant responses were analyzed and represented as mean ± standard error of mean, and subgroup analysis was conducted using Fisher's exact test.

Results:

In all, 314 of 380 residents completed the survey (83% response rate). Resident interest in research was high, with the majority of trainees responding that research will enhance their critical thinking (93%) and add to their knowledge of medicine (92%). Lack of protected time and lack of research methodology training were the most significant barriers. Over half of the residents cited the lack of a dedicated research budget as a program organization challenge. Age significantly correlated with resident perceptions of the benefits for conducting research, with trainees age 27 years or less indicating that they would be more likely to benefit from conducting research than their older counterparts (164 vs 128, P < 0.05).

Conclusion:

Improving research methodology training and dedicating structured-protected time for the scholarship are strategies to increase research output in international academic medical centers. The CREDIT-20 survey can identify specific barriers faced by trainees and assist medical educational leaders in implementing targeted interventions.

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Implementation and evaluation of a "works-in-progress" session to promote scholarship in an academic hospitalist group

BACKGROUND

Hospitalists frequently work on diverse projects, but often do not have the training and experience necessary to translate projects into peer-reviewed publications and grants.

OBJECTIVE

Describe implementation and effect of a works-in-progress (WIP) series on progress and training in scholarly work.

DESIGN

Cross-sectional survey.

SETTING

Urban academic medical center.

INTERVENTION

A weekly WIP session, named Incubator, serving as a forum where researchers, clinicians, and educators meet to review and provide feedback on projects underway across the Division of Hospital Medicine.

MEASUREMENTS

We surveyed presenters at Incubator to evaluate the impact of Incubator on scholarly activities. Responses were based on Kirkpatrick's 4-level training hierarchy: (1) Reaction: participants' satisfaction; (2) Learning: knowledge acquisition; (3) Behavior: application of skills; and (4) Results of projects. We compared responses between researchers and nonresearchers using χ² tests.

RESULTS

Of 51 surveys completed (response rate 70%), 35 (69%) projects were nonresearcher led. Reaction, behavior change, and results were all positive, with >90% respondents reporting a positive outcome in each category, a high rate of publication/funding, and 35% reporting learning as a result of Incubator. Comparison of researchers and nonresearchers revealed no significant differences, except nonresearchers reported significantly more favorable results in behavior and mentoring (P < 0.05).

DISCUSSION

A regularly scheduled, researcher-led WIP session within a largely clinically oriented hospital medicine division can provide a venue for feedback that may promote progress and practical training in scholarly projects. In addition to robust career mentorship programs and protected time, a WIP can be an adjunct to improve scholarly output among academic hospitalists. Journal of Hospital Medicine 2016;11:719-723. © 2016 Society of Hospital Medicine.

Does Research Training During Residency Promote Scholarship and Influence Career Choice? A Cross-Sectional Analysis of a 10-Year Cohort of the UCSF-PRIME Internal Medicine Residency Program

PROBLEM

The Association of Program Directors in Internal Medicine, the Accreditation Council for Graduate Medical Education, the Alliance for Academic Internal Medicine, and the Carnegie Foundation report on medical education recommend creating individualized learning pathways during medical training so that learners can experience broader professional roles beyond patient care. Little data exist to support the success of these specialized pathways in graduate medical education.

INTERVENTION

We present the 10-year experience of the Primary Care Medicine Education (PRIME) track, a clinical-outcomes research pathway for internal medicine residents at the University of California San Francisco (UCSF). We hypothesized that participation in an individualized learning track, PRIME, would lead to a greater likelihood of publishing research from residency and accessing adequate career mentorship and would be influential on subsequent alumni careers.

CONTEXT

We performed a cross-sectional survey of internal medicine residency alumni from UCSF who graduated in 2001 through 2010. We compared responses of PRIME and non-PRIME categorical alumni. We used Pearson's chi-square and Student's t test to compare PRIME and non-PRIME alumni on categorical and continuous variables.

OUTCOME

Sixty-six percent (211/319) of alumni responded to the survey. A higher percentage of PRIME alumni published residency research projects compared to non-PRIME alumni (64% vs. 40%; p = .002). The number of PRIME alumni identifying research as their primary career role was not significantly different from non-PRIME internal medicine residency graduates (35% of PRIME vs. 29% non-PRIME). Process measures that could explain these findings include adequate access to mentors (M 4.4 for PRIME vs. 3.6 for non-PRIME alumni, p < .001, on a 5-point Likert scale) and agreeing that mentoring relationships affected career choice (M 4.2 for PRIME vs. 3.7 for categorical alumni, p = .001). Finally, 63% of PRIME alumni agreed that their research experience during residency influenced their subsequent career choice versus 46% of non-PRIME alumni (p = .023).

LESSONS LEARNED

Our results support the concept that providing residents with an individualized learning pathway focusing on clinical outcomes research during residency enables them to successfully publish manuscripts and access mentorship, and may influence subsequent career choice. Implementation of individualized residency program tracks that nurture academic interests along with clinical skills can support career development within medicine residency programs.

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.

Advances in website information resources to aid in clinical practice

The World Wide Web, which has been widely implemented for roughly two decades, is humankind's most impressive effort to aggregate and organize knowledge to date. The medical community was slower to embrace the Internet than others, but the majority of clinicians now use it as part of their everyday practice. For the practicing oncologist, there is a daunting quantity of information to master. For example, a new article relating to cancer is added to the MEDLINE database approximately every 3 minutes. Fortunately, Internet resources can help organize the deluge of information into useful knowledge. This manuscript provides an overview of resources related to general medicine, oncology, and social media that will be of practical use to the practicing oncologist. It is clear from the vast size of the Internet that we are all life-long learners, and the challenge is to acquire "just-in-time" information so that we can provide the best possible care to our patients. The resources that we have presented in this article should help the practicing oncologist continue along the path of transforming information to knowledge to wisdom.

Teaching Lifelong Research Skills in Residency: Implementation and Outcome of a Systematic Review and Meta-Analysis Course

BACKGROUND

There is rising concern that fundamental scientific principles critical to lifelong learning and scientific literacy are not sufficiently addressed during residency.

OBJECTIVE

We describe the development, implementation, and evaluation of a systematic review and meta-analysis course designed to improve residents' research literacy.

INTERVENTION

We developed and implemented a novel, interactive, web-enhanced course for third-year psychiatry residents to provide the theoretical and methodological tools for conducting and reporting systematic reviews and meta-analyses. The course is based on Bloom's learning model, and established criteria for reporting systematic reviews and meta-analyses. Eight sequential learning objectives were linked to 8 well-specified assignments, with the objectives designed to build on one another and lead to the creation of a scientific manuscript.

RESULTS

From 2010-2014, 54 third-year psychiatry residents (19 unique groups) successfully completed the course as part of a graduation requirement. The majority rated the course as being good or very good, and participants reported a statistically significant increase in their confidence to conduct systematic reviews (χ(2) = 23.3, P < .05) and meta-analyses (Fisher exact test, P < .05). Estimated total dedicated resident and faculty time over a period of 36 weeks was 36 to 72 hours and 60 hours, respectively. Residents' academic productivity included 11 conference presentations and 4 peer-reviewed published manuscripts, with 2 residents who were awarded honors for their projects.

CONCLUSIONS

A formal training course in systematic reviews and meta-analyses offers a valuable learning experience, which enhances residents' research skills and academic productivity in a feasible and sustainable approach.

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.

The clinician-educator track: training internal medicine residents as clinician-educators

PROBLEM

Although resident-as-teacher programs bring postgraduate trainees' teaching skills to a minimum threshold, intensive, longitudinal training is lacking for residents who wish to pursue careers in medical education. The authors describe the development, implementation, and preliminary assessment of the novel track for future clinician-educators that they introduced in the internal medicine residency program at Beth Israel Deaconess Medical Center in 2010.

APPROACH

Categorical medical interns with a career interest in medical education apply to participate in the clinician-educator track (CET) at the midpoint of their first postgraduate year. CET residents complete a 2.5-year curriculum in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. They apply these skills in a variety of clinical settings and receive frequent feedback from faculty and peers. All CET residents design and implement at least one medical education research project.

OUTCOMES

A comprehensive evaluation plan to assess the impact of the CET on resident teaching skills, scholarly productivity, career selection, and advancement is under way. A preliminary evaluation demonstrates high satisfaction with the track among the first cohort of CET residents, who graduated in 2012. Compared with residents in the traditional resident-as-teacher program, CET residents reported higher gains in their confidence in core medical education skills.

NEXT STEPS

Although these preliminary data are promising, data will be collected over the next several years to explore whether the additional curricular time, faculty time, and costs and potential expansion to other institutions are justified.

Are researcher development interventions, alone or in any combination, effective in improving researcher behavior? A systematic review

Academic institutions funded by the Clinical and Translational Science Awards (CTSA) Program of the National Institutes of Health were challenged recently by the Institute of Medicine to expand traditional mentoring of graduate and postdoctoral scholars to include training and continuing education for faculty, professional staff, and community partners. A systematic review was conducted to determine whether researcher development interventions, alone or in any combination, are effective in improving researcher behavior. PubMed, CINAHL, and Education Research Complete databases and select journals were searched for relevant articles published from January 2000 through October 2012. A total of 3,459 papers were identified, and 114 papers were retrieved for in-depth analysis. None included randomization. Twenty-two papers reported subjects with professional degrees, interventions, and outcomes. Interventions were meetings, outreach visits, colleague mediation, audit and feedback, and multifaceted interventions. Most studies reported multifaceted interventions (68.2%), often involving mentored learning experiences, and meetings. All studies reported a change in performance, including numbers of publications or grant applications. Nine studies reported changes in competence, including writing, presentation, or analytic skills, and performance in research practice (40.9%). Even as, the quality of evidence was weak to establish causal linkages between researcher development and improved researcher behavior, nearly all the projects (81.8%) received funding from governmental agencies, professional societies, or other organizations. Those who design researcher development activities and those who evaluate the programs are challenged to develop tools and conduct studies that measure the effectiveness, costs, and sustainability of researcher development in the CTSA Program.

Facilitation of resident scholarly activity: strategy and outcome analyses using historical resident cohorts and a rank-to-match population

BACKGROUND

Facilitation of residents' scholarly activities is indispensable to the future of medical specialties. Research education initiatives and their outcomes, however, have rarely been reported.

METHODS

Since academic year 2006, research education initiatives, including research lectures, research problem-based learning discussions, and an elective research rotation under a new research director's supervision, have been used. The effectiveness of the initiatives was evaluated by comparing the number of residents and faculty mentors involved in residents' research activity (Preinitiative [2003-2006] vs. Postinitiative [2007-2011]). The residents' current postgraduation practices were also compared. To minimize potential historical confounding factors, peer-reviewed publications based on work performed during residency, which were written by residents who graduated from the program in academic year 2009 to academic year 2011, were further compared with those of rank-to-match residents, who were on the residency ranking list during the same academic years, and could have been matched with the program of the authors had the residents ranked it high enough on their list.

RESULTS

The Postinitiative group showed greater resident research involvement compared with the Preinitiative group (89.2% [58 in 65 residents] vs. 64.8% [35 in 54]; P = 0.0013) and greater faculty involvement (23.9% [161 in 673 faculty per year] vs. 9.2% [55 in 595]; P < 0.0001). Choice of academic practice did not increase (50.8% [Post] vs. 40.7% [Pre]; P = 0.36). Graduated residents (n = 38) published more often than the rank-to-match residents (n = 220) (55.3% [21 residents] vs. 13.2% [29]; P < 0.0001, odds ratio 8.1 with 95% CI of 3.9 to 17.2).

CONCLUSION

Research education initiatives increased residents' research involvement.

Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program

BACKGROUND

Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices.

CONTEXT AND PURPOSE

To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs.

RESULTS

AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate.

CONCLUSIONS

The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.

Rehabilitation in practice: Learning about research--how can trainees in rehabilitation medicine become competent in appraising and conducting research?

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee is able to critically appraise scientific, clinical and sociological research literature' and 'The trainee is able to complete a clinical audit study from the planning to final report stage'.

The shift of residents from university to non-university hospitals in Japan: a survey study

BACKGROUND

Between 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (-31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%).

OBJECTIVE

To identify potential reasons for the shift of residents from university to non-university hospitals.

DESIGN

Cross-sectional mailed survey.

PARTICIPANTS

The subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals.

MEASUREMENTS

Data on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals.

RESULTS

Compared to non-university hospitals, university hospitals were more likely to have >700 beds (55% vs. 10%, p<0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p<0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to "daily chores," "low salary," and "poor clinical opportunities." Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26-0.40) and the residency system (OR: 0.52, 95% CI: 0.40-0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60-0.99) were significantly lower for university residents than for non-university residents.

CONCLUSIONS

Hospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents' dissatisfaction.

Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know

The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.