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