Overcoming Obstacles to
Research During
Residency
Michael B. Rothberg, MD, MPH
Vice Chair for Research
Medicine Institute
Cleveland Clinic
AAMC Webinar
August 4, 2014
Today's Goals
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Understand importance of scholarship
Review ACGME requirements
Identify obstacles
Describe a successful program
Why is Scholarly Activity
Important?
Scholarship
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Discovery (new knowledge)
Integration (literature review)
Application (quality improvement)
Teaching (educational research)
Why Scholarship in Residency?
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Improve resident education
Promote quality patient care
Provide skills for lifelong learning
Enhance analytic skills
Develop critical thinking
Prepare for academia/fellowship
ACGME requirement
Understanding the ACGME
Requirements
Faculty
Establish and maintain an environment of
inquiry and scholarship with an active
research component.
From ACGME Program Requirements for Residency
Education in Internal Medicine, 2013.
Meaning…
a) Regular participation in organized clinical
discussions, rounds, journal clubs, and conferences.
b) Some members should also demonstrate
scholarship by:
(1) peer-reviewed funding;
(2) publication of original research or review
articles
(3) publication or presentation of case reports
(4) participation in national committees or
educational organizations.
c) Encourage and support residents in scholarly
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 activities
From ACGME Program Requirements for Residency Education in
Internal Medicine, 2013.
Journal of Graduate Medical Education, December 2012
Identifying Obstacles
Program Directors
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Faculty time (67%)
Funding (62%)
Mentors (51%)
Resident interest (50%)
Technical support (41%)
Levine, et al. JGIM 2005; 20:155-9
Residents
Rivera, et al. JGIM 2005; 20:366-9.
Implementation of a Resident
Research Program—The Baystate
Experience
#1 Resident Interest
Resident Research Director
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Atmosphere of inquiry
EBM curriculum
EBM conference
Work with the best residents
Get publications
Celebrate/build on successes
Research Track
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Competitive
Meets monthly
Research elective
Participation in SGIM
National presentation
Mentorship
#2 Time
Research Director
Resident Time
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Decrease time required
Encourage small projects
 Minimize data collection
 Expedite IRB approval
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Increase time available
Add protected time for research
 Create research electives
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Substitute labor
Research assistant
 Research nurse
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#3 Technical Support
Technical support
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Statistician
Sample size
 Study design
 Data collection
 Analysis
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Designated IRB member
Research assistant
IRB forms
 Data collection or entry
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Institutional Support
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Small amounts
Part A dollars
Internal or external grants
Investigators
#4 Mentors
Mentors
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Research director
Identify potential mentors
Explicit expectations for mentors and mentees
Easier to find new residents than new mentors
Departmental expectations
Mentorship qualification for new hires
Regional
National*
Publications
First Author
Research Assistant
35
Biostatistical Core
Research Director
Research Nurse
30
25
20
15
10
5
0
20012002
20022003
20032004
20042005
20052006
20062007
20072008
Academic Year
*National data not available for 2001-2003
20082009
20092010
20102011
20112012
Lessons Learned
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Leadership
Culture change
Excitement
Successful Research Director
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Fellowship trained
Broad interests
Familiar with institutional resources
Access to data
Culture Change
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Takes time
Be persistent
Focus on new residents
Excitement
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Focus energy on most promising residents
Get small victories
Build on success