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Initial successes and challenges in the development of a pediatric resident research curriculum

2006; Elsevier BV; Volume: 149; Issue: 2 Linguagem: Inglês

10.1016/j.jpeds.2006.05.001

1097-6833

Daniel Roth, Ming‐Ka Chan, Sunita Vohra,

Innovations in Medical Education

Research experience during pediatric training may promote greater involvement in research-related activities after residency.1Ledley F.D. Lovejoy F.H. Factors influencing the interest, career paths, and research activities of recent graduates from an academic, pediatric residency program.Pediatrics. 1993; 92: 436-441PubMed Google Scholar The American Academy of Pediatrics,2American Academy of Pediatrics Committee on Pediatric ResearchPromoting education, mentorship, and support for pediatric research.Pediatrics. 2001; 107: 1447-1450Crossref PubMed Scopus (28) Google Scholar the Accreditation Council for Graduate Medical Education (ACGME),3Accreditation Council for Graduate Medical EducationProgram Requirements for Residency Education in Pediatrics. 2006Google Scholar and the Royal College of Physicians and Surgeons of Canada (RCPSC)4Royal College of Physicians and Surgeons of Canada CanMeds project. http://rcpsc.medical.org/canmeds/index.php. Accessed January 1, 2006Google Scholar recommend that all pediatric trainees engage in scholarly activities. To increase resident participation in research in the Department of Pediatrics at the University of Alberta, a resident research curriculum was implemented in July 2003. Here, we describe our approach to curriculum development and its short-term impact on resident research participation and productivity. The pediatric residency program at the University of Alberta trains five to eight residents in each of the four years of training (R1 to R4). Involvement in a research project during residency was previously encouraged but not required, and there was no formal structure in place to promote research. To develop a pediatric resident research curriculum, a Resident Research Subcommittee (RRS) was formed in 2003 by the Pediatric Residency Training Committee (PRTC). It consisted of a Resident Research Coordinator, child health investigators, and resident representatives. Competencies addressed by this curriculum are those presented in the RCPSC “Objectives of Training and Specialty Training Requirements in Pediatrics”: (a) “the resident will maintain a questioning and inquisitive attitude toward medical information and an appreciation of the necessity for ongoing research to develop new knowledge”; and (b) “the resident will facilitate the education of patients, housestaff/students and other health care professionals and contribute to development of new knowledge”.5Royal College of Physicians and Surgeons of CanadaObjectives of Training and Specialty Training Requirements in Pediatrics. 1998Google Scholar To promote attainment of these competencies, the RRS established a framework for an individualized resident research experience. “Ideal goals” include a resident-led study that results in conference presentation and/or manuscript preparation, whereas “minimum expectations” are that the resident be involved in a research study and submit a written report upon completion (Table I; available at www.jpeds.com).Table IIdeal goals and minimum expectations for pediatric resident research activities during residencyIdeal goalsMinimum expectationsEnabling curricular elements •Resident takes a leading role in the design and completion of a research study, grant application, or peer-reviewed publication.•Resident presents his/her research findings at a national/international conference.•Resident understands the clinical evidence “hierarchy” and the benefits/limitations of various study designs.•Resident routinely applies critical appraisal skills when reading the literature. •Resident identifies a research question, develops a protocol, and attempts to conduct the research study before completion of residency.•Resident prepares a written report of research findings.•Resident presents research results or progress report at local rounds.•Resident regularly attends formal research curricular activities.•Resident routinely reviews the relevant literature when making clinical decisions. •Mentorship program: Research mentors, medical librarians, biostatisticians, epidemiologists, ethicists.•Protected Research Time: Research blocks during each year of training.•Funding: Annual budget of $30,000, research grants, external grants.•Formal Curricular Activities: Research seminar series, EBM seminars; Journal club; “Resident Research Day.” Open table in a new tab In early 2003, University of Alberta faculty members and residents, Canadian chief residents, and resident participants of the 15th Annual Pediatric Residents’ and Fellows’ Research Competition (May 2003) were interviewed by the resident research coordinator regarding factors thought to influence resident involvement in research (Table II; available at www.jpeds.com). Barriers cited included a lack of “protected” research time, a lack of individual resident interest or skill, and a lack of adequate faculty mentorship, similar to published findings.6Ullrich N. Botelho C.A. Hibberd P. Bernstein H.H. Research during pediatric residency predictors and resident-determined influences.Acad Med. 2003; 78: 1253-1258Crossref PubMed Scopus (38) Google Scholar Interviewees thought that positive factors included protected research time, a formal research program including access to biostatisticians and seminars addressing research methodology, and adequate funding to support conference attendance. Based on this information, a curricular structure was developed, consisting of three main components: (1) the resident research project, (2) a supportive training environment, and (3) accessible research funding. (1)R1 trainees are encouraged to develop study ideas that are interesting, important and practical, meaning they can be completed before graduation and within a realistic budget.(2)The supportive research training environment consists of four elements: (a)Protected research time: During research blocks, residents do not have daytime clinical duties and have reduced nighttime call responsibilities. Residents have a 2-week block in the first year of residency to start a literature search and protocol development. Thereafter, each resident entering their R2 to R4 years submits a written request for up to 8 weeks of protected research time per year. Residents and their supervisors remain accountable for the time spent, based on specific predetermined goals.(b)Mentorship and research support: Residents seek one or more mentors, based on their area of interest. Mentors guide the resident through the steps of study design, conduct and analysis, and obtaining funding. Medical librarians assist with literature searches, and departmental biostatisticians provide consultation to residents.(c)Awards and incentives: An annual departmental “Resident Research Day” awards monetary prizes for outstanding poster and oral presentations. Residents are required to present their work at least once during their residency training. The winner in the oral presentation category is funded to attend the national Annual Pediatric Residents’ and Fellows’ Research Competition. Residents can also receive up to $2000 CDN per resident per project per year to present their research at national or international meetings.(d)Formal curricular activities: A seminar in July of each academic year orients incoming R1 residents to research opportunities and expectations. A research seminar series runs on a 2-year cycle, comprising twenty, 75-minute academic sessions that address the steps of research protocol development. An evidence-based-medicine seminar series (approximately 12 sessions over 2 years) and a resident-run monthly journal club complement the research seminars.(3)Departmental funds allocated to resident research grants include: (a) “seed money” ($250 CDN) allocated on a noncompetitive basis to offset the administrative costs associated with preparation of a research proposal; (b) competitive resident research grants, awarded on a quarterly basis ($2000 CDN to five residents per year).Table IIBarriers and promoters of resident research success identified by pediatric residents and facultyBarriers to resident research successPromoters of resident research success •Lack of protected time dedicated to research project.•Lack of individual resident motivation or interest.•Lack of strong faculty mentorship, research supervision, or clinician-scientist “role-modeling.”•Inadequate knowledge and skills pertaining to research study design and methodology.•Resident involvement in projects felt to be “too ambitious” for completion within duration of residency.•Lack of residents’ understanding of the ethical review process.•Lack of accountability and inadequate methods of evaluating resident progress in their research activities. •Protected research time beginning in the first year of residency.•Resident research orientation folder that includes the following information: (a)Descriptive list of potential research supervisors and mentors.(b)Up-to-date list of local, regional, national and international funding sources.(c)Outline of local research resources.•Academic lectures and seminars that address: (a)Different types of research opportunities that are available to residents.(b)Preparation of grant applications and proposals for ethics committees.(c)Research methodology•Access to free research support, including statisticians and administrative assistance.•The opportunity to “fast-track” resident research proposals through the institutional ethics review committees.•Provision of “seed money” with which to initiate research project.•Opportunities to present research findings at a local level, with support and recognition by faculty.•Research awards and other material incentives. Open table in a new tab Preliminary assessment of the curriculum was based on the short-term difference in precurriculum and postcurriculum resident research productivity, as measured by the proportion of residents with at least one conference presentation, manuscript publication, or grant. Precurricular and postcurricular differences were assessed for statistical significance by using the χ2 test. Statistical significance was a two-sided value of P < .05. All residents currently identify a research mentor and initiate an individual research project before the beginning of the R2 year. Residents have scheduled up to 12 weeks of cumulative protected research time during their first R1 to R3 years; before curriculum implementation, residents had a maximum of 8 total weeks of protected research time during the first 3 years. Compared with the year preceding curriculum implementation, there was an increase in the proportion of residents who had at least one conference presentation, manuscript publication, and internal or external research grant 2 years after curriculum initiation; however, none of the observed differences were statistically significant (Table III; available at www.jpeds.com).Table IIIProportion of residents with at least one conference presentation, research article (submitted or published manuscripts), or research grant during residency before and after the introduction of the new research curriculumYear of residencyConference presentationsResearch articlesResearch grantsBeforeAfterBeforeAfterBeforeAfterR10% (0/5)0% (0/8)0% (0/5)0% (0/8)20% (1/5)13% (1/8)R220% (1/5)40% (2/5)40% (2/5)0% (0/5)20% (1/5)40% (2/5)R360% (3/5)80% (4/5)0% (0/5)20% (1/5)20% (1/5)20% (1/5)R440% (2/5)60% (3/5)⁎One resident completed a fourth year of training at a different institution, but the data include presentations, articles, and grants during only the resident’s first 3 years at the University of Alberta.20% (1/5)80% (4/5)⁎One resident completed a fourth year of training at a different institution, but the data include presentations, articles, and grants during only the resident’s first 3 years at the University of Alberta.0% (0/5)60% (3/5)⁎One resident completed a fourth year of training at a different institution, but the data include presentations, articles, and grants during only the resident’s first 3 years at the University of Alberta.Total30% (6/20)39% (9/23)15% (3/20)22% (5/23)15% (3/20)30% (7/23)SignificanceP = .531P = .571P = .232Before = at the end of the 2002–2003 term; after = at the end of the 2004–2005 term. One resident completed a fourth year of training at a different institution, but the data include presentations, articles, and grants during only the resident’s first 3 years at the University of Alberta. Open table in a new tab Before = at the end of the 2002–2003 term; after = at the end of the 2004–2005 term. Since the implementation of a pediatric resident research curriculum, most final-year residents have presented their research findings at a scientific meeting, published or submitted a manuscript, or have received a research grant. Overall resident productivity increased relative to precurricular rates, yet the changes were not statistically significant; this probably was due to inadequate power because of the unavoidably small sample size. In a recent cross-Canada survey of pediatric residents, we found that research productivity was associated with the number of protected research weeks and departmental support for travel to scientific meetings (Roth et al, unpublished results). Both of these elements were emphasized in our new curriculum, suggesting that they may be factors that contributed to increased productivity. The increase in resident productivity that temporally coincided with implementation of the new curriculum suggests a causal association but may be related to confounding factors, including different levels of research interest between the resident groups, faculty support for resident research that is increasing independently of the curriculum, and a growing perception among residents of the need for research experience for career advancement. In addition to financial constraints, a major challenge involved in the implementation of a resident research curriculum is the difficulty in designating resident work hours for research in light of concerns that there is too little time to acquire clinical pediatric skills.7Moreno M.A. Resident stress revisited a senior pediatric resident’s point of view.Pediatrics. 2003; 112: 411-414Crossref PubMed Scopus (11) Google Scholar Educational priorities have recently become more controversial due to mandated reductions in the resident work week.8Jones Jr, M.D. More than a matter of time.Pediatrics. 2004; 113: 1396-1398Crossref PubMed Scopus (3) Google Scholar Given these time pressures, we accommodated differences in individual resident research interests by allowing variability in the amount of protected time each resident allocated to research. Mechanisms to permit even greater flexibility, such as “research streams,”9Kaczorowski J. Sellors J. Walsh A. The beginning of the research stream in family medicine residency program at McMaster University.BMC Med Educ. 2001; 1: 1Crossref PubMed Scopus (5) Google Scholar may help selected residents pursue careers as clinician-scientists. In conclusion, we have shown that a resident research curriculum can be successfully implemented and may improve resident research productivity in the short term. However, it remains to be determined whether the curriculum creates sustained interest in child health research beyond residency. References available at www.jpeds.com.