Transcript Developing an Improved Residency Training Continuum for

Developing an Improved
Residency Training Continuum
for Future Academic Physicians
Presented by
Leila Mei Pang, M.D.
Associate Professor of Anesthesiology & Pediatrics
Associate Vice-Chairman, Resident Education
College of Physicians & Surgeons of Columbia
University
New York, New York
Models Already in Existence
ABIM
Research Pathway
ABP Integrated Research
Pathway
ABA Clinical Scientist Track
ABIM Research Pathway
~ 1% of residents
2 Years Categorical Internal Medicine
Internal Medicine Training
Total 5 years
Clinical Subspecialty Training
Total 6 - 7 years
3 years research
80% research; 20% clinical
Leading to graduate degree or equivalent
Eligible for medicine boards PGY-5
1 - 2 years subspecialty training
3 years research
80% research; 10% clinical
Eligible for medicine boards PGY-4
Eligible for subspecialty boards PGY 6-7
ABP Integrated Research
Pathway
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Designed to accommodate MD/PhD graduates to
continue ongoing research during their pediatric
residency
During the 3 years of general pediatric training, a
max. of 11 months may be in research with no
more than 1 month in PL-1 and at least 5 months
in PL-3 year
Must apply before entering or during the first 9
months of the PL-1 year
12 months of additional clinical experience must
be completed to be eligible for general pediatric
boards
ABA Clinical Scientist Track
Option A: 6 months of clinical or laboratory
research during 48 months of training (12
mos CB + 30 mos Clinical Anesthesia)
 Option B: At least 18 months of clinical or
laboratory research during 60 months of
training (12 mos CB + 30 mos Clinical
Anesthesia)
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Informal Model - Surgical
Research Track @ Columbia
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Resident candidates are informed that if they want to
do a year of research, it is allowed; department’s
commitment - time and money
Residents are exposed to research in the department
during an August Research Symposium
During PGY 1 year competitive applications are
submitted for start-up funds from the Department,
naming a specific faculty as mentor
Research year usually occurs between their PGY 2 and
PGY 3 year with night call duties only so GME slot is
preserved
Progress report is expected; may extend by l year
What Happens to these
Residents?
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ABIM - Most remain in academic practices with
about 30% continuing with research
ABP - <1% elect this track; usually remain in
academic practices
ABA
– Option A: Usually go to private practice or a staff
position at a teaching hospital
– Option B: Usually are staff in academic departments
continuing research
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Surgery
– Most end up in academic departments but few continue
research
Why are the outcomes different?
ABIM expects the resident to obtain an
advanced degree, if not already acquired, so
commitment to research is emphasized.
AS A RESULT:
 Departments of Medicine over the past
several years get the lion’s share of NIH
funding awarded to medical school
departments
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Outcomes - continued
Pediatrician Scientists already have
MD/PhD degrees and are encouraged to
continue research during their residency
As a result
 Pediatric departments received the 4th
highest number of NIH grants but are 3rd
highest in $ amount in 2001
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Awards to Medical School Departments
Fiscal Year 2001
Department
#
Total Award
1
Medicine
5,626
$2.3 billion
2
Psychiatry
1,782
$649 million
3
Pathology
1,395
$458 million
4
Pediatrics
1,335
$470 million
5
Surgery
948
$298 million
6
Neurology
752
$282 million
7
Radiology
582
$203 million
8
Ophthalmology
484
$149 million
9
OB/Gyn
181
$128 million
10
Anesthesiology
242
$ 71 million
11
Otolaryngology
195
$ 63 million
12
Dermatology
181
$ 44 million
13
Orthopedic Surgery
112
$ 24 million
14
Family Practice
97
$ 38 million
15
Physical Med & Rehab
42
$ 15 million
Outcomes
Anesthesiologists make up 6% of the
physician workforce but get only 0.7% of
the NIH funding
 Academic anesthesiologists fare better in
terms of percentage funding in the
Surgical/Anesthesia/Trauma study section
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Outcomes
Academic anesthesiologists spend only 7% of their time in
research/scholarly activity compared to 12% in other clinical
departments
Anesthesiology
All Clinical Dept
Billable Clinical
64%
52%
Activity
Teaching/Super14%
15%
vision
VA/other non10%
7%
billable
Research/scholarly activity
Administration
From: International
7%
12%
5%
9%
Anesthesiology Clinics,
Vol. 38, Spring 2000
What Is My Department Doing
to Affect the Outcome?
Apgar Research Scholar Fellowships are
offered on a competitive bases to our CA-1
residents who commit to up to 24 months after
training to research. Goal: Future Faculty
– Clinical Scholars are involved in clinical training in
a subspecialty area plus clinical research
– Basic Science Scholars are involved in basic
science research but spend 20% of their time
clinically
Univ. of Wisconsin Medical School
Guidelines for Protected time for
Tenure-Track Assistant Professors
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Hire on tenure track only those who have
demonstrated commitment to research
Plan for adequate research start-up funds and
space before arrival
Chairperson’s responsibility to provide for
sufficient protected time for research
Protect from committee assignments and other
diversions
Provide mentoring and clear annual feedback from
senior faculty either locally or from other schools
Encourage attendance at University sponsored
professional development seminars and meetings