Transcript Research in Residency - VCU School of Medicine

EASE: Engaging Residents
in Research
Evan R. Reiter, MD, FACS
Program Director, Vice Chair
Dept of Otolaryngology – Head & Neck Surgery
Disclosures
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Sadly, I have no financial interests in any
external entity related to the work to be
presented here.
Mary Alice refused to grant my request for an
honorarium.
I do not have all the answers.
Research in Residency
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Why?
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What?
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How?
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Why? (yes I know, again)
VCUHS PD Resident Research Survey
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Survey link on Surveymonkey.com sent via PD
email list
Respondents: N = 43 of total programs
Core residency 20, fellowship 23
 Specialties
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Medical (med, peds, EM, etc) – 17
 Surgical – 8
 Hospital – 9
 Other – 9 (eg, psych, derm, ophtho, dental, forensics,
radiology, nuclear med, others)
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“Why do I need to do research if I’m going
into private practice anyway?”
-Anonymous Resident*
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Answers to said resident:
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Your residency program may require it.
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To learn to critically appraise the
medical literature.
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To expand your mind.
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To learn some new skills
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To help get the job or fellowship
position of your choice.
*Disclaimer: Resident was confabulated for purposes of this talk. No real residents
were harmed or forced to violate duty hour limits for purposes of this talk.
ACGME Common Program
Requirements
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IV.B. Residents’ Scholarly Activities
IV.B.1. 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.
IV.B.2. Residents should participate in scholarly activity.
[As further specified by the Review Committee]
IV.B.3. The sponsoring institution and program should allocate
adequate educational resources to facilitate resident involvement
in scholarly activities.
[As further specified by the Review Committee]
Residency Research Requirements
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Internal Medicine: “ Each program must provide
an opportunity for residents to participate in
research or other scholarly activities, and residents
must participate actively in such activities.
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General Surgery: “…The participation of
residents in clinical and/or laboratory research is
encouraged.”
Residency Research Requirements
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ENT: “…The educational program should provide a
structured research experience for the residents, sufficient to
result in an understanding of the basic principles of study
design, performance, analysis, and reporting. The research
experience may be clinical or basic in nature, and should
reflect careful advice by, and planning with the faculty.
Facilities and protected time for research by the residents
should also be provided, with guidance and supervision by
the faculty.
Residency Research: Key Ingredients
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Time
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Training
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Facilities
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Mentorship
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Motivation/Incentives?
VCUHS PD Resident Research Survey
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Do you require any particular type of research?
Laboratory research required:
1 (7 %)
 Clinical or laboratory projects acceptable: 14 (93 %)
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Research and Scholarly Activities
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Book chapter
Invited review articles
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Online resources
Journals
Original Research
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Case reports
Case series/retrospective
reviews
Meta analysis
Prospective studies
Bench research
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Other scholarly activities
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Teaching conference
presentations
Grand rounds
presentations
QAI or “Systems Based
Practice” Projects
Research and the Core Competencies
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Interpersonal and Communication Skills
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Residents must demonstrate interpersonal and communication skills that
result in the effective exchange of information and collaboration with
patients, their families, and health professionals.
Professionalism
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Residents must demonstrate a commitment to carrying out professional
responsibilities and an adherence to ethical principles. Residents are
expected to demonstrate:
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IV.A.5.e).(1) compassion, integrity, and respect for others;
IV.A.5.e).(3) respect for patient privacy and autonomy;
IV.A.5.e).(4) accountability to patients, society and the profession; and,
Research and the Core Competencies
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Medical Knowledge
 Residents must demonstrate knowledge of established and evolving
biomedical, clinical, epidemiological and social-behavioral sciences, as well
as the application of this knowledge to patient care.
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Practice-based Learning and Improvement
 Residents must demonstrate the ability to investigate and evaluate their care
of patients, to appraise and assimilate scientific evidence, and to
continuously improve patient care based on constant self-evaluation and
life-long learning.
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Systems-based Practice
 IV.A.5.f).(5) work in interprofessional teams to enhance patient safety and
improve patient care quality;
Research and the Core Competencies:
Documentation
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Research rotation evaluation
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Include multiple evaluators if possible
Core competency based
Semi-Annual resident review
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Include running list of projects, with outcomes (presentations,
publications, etc)
Include other scholarly projects/activities
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Departmental conference attendance, participation/presentations
National/regional conference attendance
QAI/SBP project summary
Departmental
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Annual program review: include discussion of resident research
productivity/performance, and resident research program overall as
program outcome measure
Resident research forums/research oversight committees: evaluate
progress, summarize resident productivity
Research and the Core Competencies:
Documentation
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Semi Annual Review Summary
VCUHS PD Resident Research Survey
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Do residents/fellows do research – 93% (40) yes
Do program requirements specify mandatory
research time? 36% (14) yes
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What do PR specify for minimum time?
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47% (7) not specified, 3: < 6 mo, 1: 6-11.9 mo, 3: > 12
mo
Are clinical duties allowed during research time?
No clinical duties allowed - 7% (1)
 Some clinical duties allowed - 28% (4)
 Not specified – 50% (7)
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VCUHS PD Resident Research Survey
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Approximately
what percentage
of your trainees
get involved in
some form of
research?
% involved
in research
%
N
0%
0
0
1 - 24%
20
8
25 - 49%
5
2
50 – 74%
18
7
75 – 99%
13
5
100%
45
18
Resident Research: Innovations
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Training: Resident scholar program
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Application submitted to residency research director, with
project description, mentor.
If approved, 4 month elective: 1 month in subspecialty
specific consult service, 3 mos research project
RSP residents more likely to get fellowship (89% vs. 46%)
Participation in program tripled over first 3 years
Byrnes AB et al. The resident scholar program: a research training
opportunity for internal medicine house staff. J Cancer Educ. 2007;
22(1):47-9.
Resident Research: Innovations
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Improving compliance with research requirement
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Faculty submitted lists of novel or ongoing projects, list compiled
and sent to all in dept.
Project milestones defined
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Identification of project and mentor
Human Subjects Course certification
IRB submission dates
Midyear progress reports, final submission dates
Rate of case reports 65% → 30% → 25% by 2 yrs
Publications from 3 → 13; presentations 5 →13
Fisher C et al, Improving participation and quality of clinical research in a
university-based general surgery residency program. Am Surg. 2010;
76(7):741-2.
VCUHS PD Resident Research Survey
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Research Resources: Training
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Do residents engaged in research take Citi Training Course?
Yes 63%
Does educational curriculum include training on:
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IRB processes – 33 %
Biostatistics – 67 %
Research software – 3 %
Study design – 67 %
Research ethics – 50 %
Grant writing – 7 %
Manuscript preparation – 33 %
VCUHS Research Training
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VCU ORSP:
http://www.research.vcu.edu/orsp/index.htm
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Human Subjects: Collaborative Institutional
Training Initiative (CITI) course:
www.citiprogram.org
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Required by over 400 institutions
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Biomedical or social/behavioral research courses
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Modular, takes 4-6 hours for all parts
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On-line verification of completion
VCUHS Research Training
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VCU ORSP:
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Animal Subjects:
https://www.vcu.edu/research/iacuc/events.htm
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IACUC required webinar course for new faculty, PIs.
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Additional training on a wide variety of relevant topics
available via web resources and live training sessions.
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Citiprogram online course on animal care and use also
available, modules available specifically focused on
working with a variety of different animals
VCUHS Center for Clinical and
Translational Research
Mission:
To participate and facilitate multidisciplinary, clinical and
translational research in order to develop, disseminate
and apply innovations to improve individual health and
the well-being of our community. Specifically, the
CCTR will provide resources to support and train our
clinical and translational researchers.
CCTR
Core Units of the Center
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Research Incubator
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Research Education and Training
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Community Engagement and Research
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Participant and Clinical Interaction Resources
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Biomedical Informatics
Research Incubator
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Director, CCTR – Dr. John Clore
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Director, RI – Dr. Chris Gennings
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Other resources:
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Research Liaison, Community Research Liaison,
Biostatisticians, Grant Writer
Center for Clinical and Translational Research
1200 East Clay Street, Suite 2000
Telephone: 7-1519
E-mail: [email protected]
http://www.cctr.vcu.edu/research_incubator/index.html
Research Education and Training
Programs Available
CCTR Educational Platform
Clinical
Investigator
Core
Program
C/T
Scientist
Certificate
Program
C/T
Master’s
and
Doctorate
Program
Postdoctoral
Mentored
(K12)
Research Education and Training
Internet Clinical Investigator Core
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Core Classes
Regulatory Requirements for C/T Research
 Basic Research Methodology for C/T Research
 Study Design and Analysis in C/T Research
 Research Ethics
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Available in Fall 2008
Web-based curriculum
Nine Credits
Research Education and Training
Programs Available
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Clinical and Translational Sciences Certificate
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Open to students, staff, faculty, community-based
clinicians, professional research associates, and
coordinators
Master’s and Doctorate in Clinical and
Translational Sciences
Competitive application process
 Strong focus on interdisciplinary clinical and
translational research
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Coming soon to a conference room near you…
“Research for Residents: A Primer”
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Proposed weekly seminar sponsored by CCTR and
GMEC
Evenings, with light dinner provided
Suggested topics:
Defining research studies
 Research methods
 Biostat basics
 Scientific integrity and research ethics
 Critically evaluating literature
 Writing research proposals
 Translational research and new horizons
Kudos to Stephanie Call and GME Education Committee,
Jessica Waugh, CCTR, and May Alice.
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VCUHS PD Resident Research Survey
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Research Resources
Dedicated fulltime researchers (MD or PhD) in
Dept/Division? 70 % yes
 Basic research labs facilities in Dept/Division? 70 %
yes
 Part or fulltime research coordinator/nurse in
Dept/Division? 62 % yes
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VCUHS PD Resident Research Survey
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Research resources: funding sources
Funding sources
N
%
NIH Investigator grant(s)
11
30
NIH research training
grant(s)
4
10
Private grant(s)
18
49
Internal grant(s)
19
51
Endowed fund
6
16
Dept operating funds
27
73
Other
5
14
VCUHS PD Resident Research Survey
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Financial support for travel to present research:
Podium
n
Podium
%
Poster
n
Poster
%
No
3
8
5
13
Mentor/Lab
pays
< $500
1
3
1
3
1
3
3
8
$500-1000
9
23
11
28
Full cost
21
53
15
39
VCUHS PD Resident Research Survey
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Research Resources: mentorship
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Do you assign or does trainee select research
mentor?
Yes, assigned – 5 %
 Yes, selected by trainee – 33 %
 Project specific mentor(s) – 59 %
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Do you have departmental committee to oversee
trainee research? Yes 37 %
 Are trainees required to present at dept grand
rounds or research forum? Yes 67%
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Resident Research: Mentorship
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VCUHS Faculty Mentoring Guide 1997, 2002.
Resident Research: Mentorship
Resident Research: Innovations
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Mentoring; Research teams
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Research teams: PGY-4/5, PGY-2/3, intern, research
mentor, research specialist (helps with design, data analysis,
manuscript, presentations)
All residents contribute to development and performance of
study
Monthly meetings of team
Compared 8 yrs before and after teams: 33% increase in
presentations, 13% in publications
Lohr J et al, Stimulating resident research in a general surgery residency
community program. Curr Surg. 2006; 63(6):426-34.
VCUHS PD Resident Research Survey
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What do you feel are the benefits of engaging trainees
in research?
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“Critical thinking, a less mechanistic approach to patient
care.”
“Appreciate the science behind what they do everyday.”
“Increase program’s strength. Attract academic oriented
residents.”
“Recognition of importance of three-legged stool of
academic institution.”
“Develop expertise…Become content experts.”
“Potential engagement in academic career.”
“Career development, ability to attend meetings.”
VCUHS PD Resident Research Survey
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Do you have suggestions to “incentivize”
trainees to get involved with research?
“make it mandatory, provide adequate
mentorship/assistance.”
 “…had to do with whom one recruits in Match…”
 “More internal funding sources for small laboratory
projects.”
 “having a really good mentor…makes all the
difference.”
 “More collaboration between departments.”
 “Pay for travel to present research.”
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VCUHS PD Resident Research Survey
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What do you see as potential challenges to increasing
trainee involvement in research?
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“Time pressures of clinical care.”
“increased clinical requirements with less time due to duty
hours.”
“Many have no interest…if they plan to be clinicians fulltime.”
“IRB delay time.”
“Mentors. Even our faculty are struggling with time and
money…”
“Good research projects within the program that could be
completed in a reasonable time period.”
VCUHS PD Resident Research Survey
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Final comments, suggestions on resident research?
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“Hard to generate interest-dept has never had a strong
supporting culture.”
“more organized structure in research four housestaff
including realistic expectations…”
“Specifically allocated funds from the institution for residents
research.”
“funding is not really a problem since the dept policy is to
extinguish “unfunded research…””
“Critical part of residency.”
The Final “Why?”
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CASH
AWARDS
At VCUHS Resident Research Day
SHOW…ME…THE...MONEY!!
VCUHS Resident Research Day
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Annual event since 2004
Basic science or clinical
research
Abstracts rated, assigned to
oral or poster presentation
Cash awards for basic
science and clinical
research, posters
VCUHS Resident Research Day
2006
Depts/
Divs
80
13
70
Abstracts Submitted
60
2007
13
50
2008
13
40
2009
11
20
2010
2011
14
19
Total
Basic Sci
Clinical
30
10
0
2006 2007 2008 2009 2010 2011
VCUHS Resident Research Day 2012
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Date: Thursday June 7, 12 – 6 PM
Place: MMRB
Abstracts Due: Friday March 16th
Abstract Format
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Structured: Background, Methods,
Results, Conclusions
Word count 250 words or less
Electronically submitted (email)
Thank you!
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Questions, comments, discussion….