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 Understand importance of scholarship Understand importance of scholarship Review ACGME requirements Review ACGME requirements Identify obstacles Identify obstacles Describe a successful program Describe a successful program

Why is Scholarly Activity Important?

Scholarship 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 Residency? Improve resident education Improve resident education Promote quality patient care Promote quality patient care Provide skills for lifelong learning Provide skills for lifelong learning Enhance analytic skills Enhance analytic skills Develop critical thinking Develop critical thinking Prepare for academia/fellowship Prepare for academia/fellowship ACGME requirement 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. 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 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: Residents

Implementation of a Resident Research Program—The Baystate Experience

#1 Resident Interest

Resident Research Director Atmosphere of inquiry Atmosphere of inquiry EBM curriculum EBM curriculum EBM conference EBM conference Work with the best residents Work with the best residents Get publications Get publications Celebrate/build on successes Celebrate/build on successes

Research Track Competitive Competitive Meets monthly Meets monthly Research elective Research elective Participation in SGIM Participation in SGIM National presentation National presentation Mentorship Mentorship

#2 Time

Research Director

Resident Time Decrease time required Decrease time required Encourage small projects Encourage small projects Minimize data collection Minimize data collection Expedite IRB approval Expedite IRB approval Increase time available Increase time available Add protected time for research Add protected time for research Create research electives Create research electives Substitute labor Substitute labor Research assistant Research assistant Research nurse Research nurse

#3 Technical Support

Technical support Statistician Statistician Sample size Sample size Study design Study design Data collection Data collection Analysis Analysis Designated IRB member Designated IRB member Research assistant Research assistant IRB forms IRB forms Data collection or entry Data collection or entry

Institutional Support Small amounts Small amounts Part A dollars Part A dollars Internal or external grants Internal or external grants Investigators Investigators

#4 Mentors

Mentors Research director Research director Identify potential mentors Identify potential mentors Explicit expectations for mentors and mentees Explicit expectations for mentors and mentees Easier to find new residents than new mentors Easier to find new residents than new mentors Departmental expectations Departmental expectations Mentorship qualification for new hires Mentorship qualification for new hires

Research Director Biostatistical Core Research Assistant Research Nurse *National data not available for

Lessons Learned

Leadership Leadership Culture change Culture change Excitement Excitement

Successful Research Director Fellowship trained Fellowship trained Broad interests Broad interests Familiar with institutional resources Familiar with institutional resources Access to data Access to data

Culture Change Takes time Takes time Be persistent Be persistent Focus on new residents Focus on new residents

Excitement Focus energy on most promising residents Focus energy on most promising residents Get small victories Get small victories Build on success Build on success