overcoming obstacles to research during residency michael b. rothberg, md, mph vice chair for...
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Overcoming Overcoming Obstacles to Obstacles to
Research During Research During ResidencyResidencyMichael B. Rothberg, Michael B. Rothberg,
MD, MPHMD, MPH
Vice Chair for ResearchVice Chair for Research
Medicine InstituteMedicine Institute
Cleveland ClinicCleveland ClinicAAMC Webinar August 4, 2014AAMC Webinar August 4, 2014
Today's GoalsToday's Goals
Understand importance of Understand importance of scholarshipscholarship
Review ACGME requirementsReview ACGME requirements Identify obstaclesIdentify obstacles Describe a successful programDescribe a successful program
Why is Scholarly Activity Why is Scholarly Activity Important?Important?
ScholarshipScholarship
Discovery (new knowledge)Discovery (new knowledge) Integration (literature review)Integration (literature review) Application (quality improvement)Application (quality improvement) Teaching (educational research)Teaching (educational research)
Why Scholarship in Why Scholarship in Residency?Residency?
Improve resident educationImprove resident education Promote quality patient carePromote quality patient care Provide skills for lifelong learningProvide skills for lifelong learning Enhance analytic skillsEnhance analytic skills Develop critical thinkingDevelop critical thinking Prepare for academia/fellowshipPrepare for academia/fellowship ACGME requirementACGME requirement
Understanding the ACGME Understanding the ACGME RequirementsRequirements
FacultyFaculty
Establish and maintain an Establish and maintain an environment of inquiry and environment of inquiry and scholarship with an active scholarship with an active research component.research component.
From ACGME Program Requirements for Residency Education in Internal Medicine, 2013.
Meaning…Meaning…a) Regular participation in organized clinical a) Regular participation in organized clinical
discussions, rounds, journal clubs, and discussions, rounds, journal clubs, and conferences.conferences.
b) Some members should also demonstrate b) Some members should also demonstrate scholarship by: scholarship by:(1) peer-reviewed funding;(1) peer-reviewed funding;(2) publication of original research or review (2) publication of original research or review articlesarticles(3) publication or presentation of case reports (3) publication or presentation of case reports (4) participation in national committees or (4) participation in national committees or educational organizations.educational organizations.
c) Encourage and support residents in scholarly c) Encourage and support residents in scholarly activities. activities.
Residents’ Scholarly Activities
•The curriculum must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care
•Residents should participate in scholarly activity
•The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activitiesFrom ACGME Program Requirements for Residency Education in Internal Medicine, 2013.
Journal of Graduate Medical Education, December 2012
Identifying Identifying ObstaclesObstacles
Program DirectorsProgram Directors
Faculty time (67%)Faculty time (67%) Funding (62%)Funding (62%) Mentors (51%)Mentors (51%) Resident interest (50%)Resident interest (50%) Technical support (41%)Technical support (41%)
Levine, et al. JGIM 2005; 20:155-9
Rivera, et al. JGIM 2005; 20:366-9.
Residents
Implementation of a Implementation of a Resident Research ProgramResident Research Program—The Baystate Experience—The Baystate Experience
#1 Resident #1 Resident InterestInterest
Resident Research Resident Research DirectorDirector
Atmosphere of inquiryAtmosphere of inquiry EBM curriculumEBM curriculum EBM conferenceEBM conference Work with the best residentsWork with the best residents Get publicationsGet publications Celebrate/build on successesCelebrate/build on successes
Research TrackResearch Track
CompetitiveCompetitive Meets monthlyMeets monthly Research electiveResearch elective Participation in SGIMParticipation in SGIM National presentationNational presentation MentorshipMentorship
#2 Time #2 Time
Research Research DirectorDirector
Resident TimeResident Time Decrease time requiredDecrease time required
Encourage small projects Encourage small projects Minimize data collectionMinimize data collection Expedite IRB approval Expedite IRB approval
Increase time availableIncrease time available Add protected time for researchAdd protected time for research Create research electivesCreate research electives
Substitute laborSubstitute labor Research assistantResearch assistant Research nurseResearch nurse
#3 Technical #3 Technical SupportSupport
Technical supportTechnical support
StatisticianStatistician Sample sizeSample size Study designStudy design Data collectionData collection AnalysisAnalysis
Designated IRB memberDesignated IRB member Research assistantResearch assistant
IRB formsIRB forms Data collection or entryData collection or entry
Institutional SupportInstitutional Support
Small amountsSmall amounts Part A dollarsPart A dollars Internal or external grantsInternal or external grants InvestigatorsInvestigators
#4 #4 MentorsMentors
MentorsMentors Research directorResearch director Identify potential mentorsIdentify potential mentors Explicit expectations for mentors and Explicit expectations for mentors and
menteesmentees Easier to find new residents than new Easier to find new residents than new
mentorsmentors Departmental expectationsDepartmental expectations Mentorship qualification for new hiresMentorship qualification for new hires
0
5
10
15
20
25
30
35
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
2008-2009
2009-2010
2010-2011
2011-2012
Academic Year
Regional
National*
Publications
First Author
Research Director Biostatistical Core
Research Assistant Research Nurse
*National data not available for 2001-2003
Lessons LearnedLessons Learned
LeadershipLeadership Culture changeCulture change ExcitementExcitement
Successful Research Successful Research DirectorDirector
Fellowship trainedFellowship trained Broad interestsBroad interests Familiar with institutional resourcesFamiliar with institutional resources Access to dataAccess to data
Culture ChangeCulture Change
Takes timeTakes time Be persistentBe persistent Focus on new residentsFocus on new residents
ExcitementExcitement
Focus energy on most promising Focus energy on most promising residentsresidents
Get small victoriesGet small victories Build on successBuild on success