EASE: Engaging Residents in Research

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EASE Engaging Residents in Research

• Evan R. Reiter, MD, FACS
• Program Director, Vice Chair
• Dept of Otolaryngology Head Neck Surgery

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Disclosures

• 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.

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Research in Residency

• Why?
• What?
• How?
• Why? (yes I know, again)

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VCUHS PD Resident Research Survey

• Survey link on Surveymonkey.com sent via PD email
  list
• Respondents N 43 of total programs
• Core residency 20, fellowship 23
• Specialties
• 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 Im going into
private practice anyway?-Anonymous Resident

• Answers to said resident
• Your residency program may require it.
• To learn to critically appraise the medical
  literature.
• To expand your mind.
• To learn some new skills
• 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.
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ACGME Common Program Requirements

• 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

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Residency Research Requirements

• 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.
• General Surgery The participation of
  residents in clinical and/or laboratory research
  is encouraged.

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Residency Research Requirements

• 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.

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Residency Research Key Ingredients

• Time
• Training
• Facilities
• Mentorship
• Motivation/Incentives?

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VCUHS PD Resident Research Survey

• 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

• Book chapter
• Invited review articles
• Online resources
• Journals
• Original Research
• Case reports
• Case series/retrospective reviews
• Meta analysis
• Prospective studies
• Bench research

• Other scholarly activities
• Teaching conference presentations
• Grand rounds presentations
• QAI or Systems Based Practice Projects

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Research and the Core Competencies

• Interpersonal and Communication Skills
• 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
• Residents must demonstrate a commitment to
  carrying out professional responsibilities and an
  adherence to ethical principles. Residents are
  expected to demonstrate
• 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,
•  

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Research and the Core Competencies

• 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.
•  
• 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.
• Systems-based Practice
• IV.A.5.f).(5) work in interprofessional teams to
  enhance patient safety and improve patient care
  quality

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Research and the Core CompetenciesDocumentation

• Research rotation evaluation
• Include multiple evaluators if possible
• Core competency based
• Semi-Annual resident review
• Include running list of projects, with outcomes
  (presentations, publications, etc)
• Include other scholarly projects/activities
• Departmental conference attendance,
  participation/presentations
• National/regional conference attendance
• QAI/SBP project summary
• Departmental
• 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

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Research and the Core CompetenciesDocumentation

• Semi Annual Review Summary

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VCUHS PD Resident Research Survey

• Do residents/fellows do research 93 (40) yes
• Do program requirements specify mandatory
  research time? 36 (14) yes
• What do PR specify for minimum time?
• 47 (7) not specified, 3 lt 6 mo, 1 6-11.9 mo,
  3 gt 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
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

• Approximately what percentage of your trainees
  get involved in some form of research?

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Resident Research Innovations

• Training Resident scholar program
• 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.

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Resident Research Innovations

• Improving compliance with research requirement
• Faculty submitted lists of novel or ongoing
  projects, list compiled and sent to all in dept.
• Project milestones defined
• 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.

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VCUHS PD Resident Research Survey

• Research Resources Training
• Do residents engaged in research take Citi
  Training Course? Yes 63
• Does educational curriculum include training on
• IRB processes 33
• Biostatistics 67
• Research software 3
• Study design 67
• Research ethics 50
• Grant writing 7
• Manuscript preparation 33

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VCUHS Research Training

• VCU ORSP http//www.research.vcu.edu/orsp/index.h
  tm
• Human Subjects Collaborative Institutional
  Training Initiative (CITI) course
  www.citiprogram.org
• Required by over 400 institutions
• Biomedical or social/behavioral research courses
• Modular, takes 4-6 hours for all parts
• On-line verification of completion

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VCUHS Research Training

• VCU ORSP
• Animal Subjects https//www.vcu.edu/research/iacu
  c/events.htm
• IACUC required webinar course for new faculty,
  PIs.
• Additional training on a wide variety of relevant
  topics available via web resources and live
  training sessions.
• Citiprogram online course on animal care and use
  also available, modules available specifically
  focused on working with a variety of different
  animals

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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.

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CCTRCore Units of the Center

• Research Incubator
• Research Education and Training
• Community Engagement and Research
• Participant and Clinical Interaction Resources
• Biomedical Informatics

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Research Incubator

• Director, CCTR Dr. John Clore
• Director, RI Dr. Chris Gennings
• Other resources
• 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
pmdillon_at_vcu.edu http//www.cctr.vcu.edu/research_
incubator/index.html
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Research Education and TrainingPrograms Available

• CCTR Educational Platform

Postdoctoral Mentored (K12)
C/T Masters and Doctorate Program
C/T Scientist Certificate Program
Clinical Investigator Core Program
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Research Education and TrainingInternet Clinical
Investigator Core

• 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
• Available in Fall 2008
• Web-based curriculum
• Nine Credits

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Research Education and TrainingPrograms Available

• Clinical and Translational Sciences Certificate
• Open to students, staff, faculty, community-based
  clinicians, professional research associates, and
  coordinators
• Masters 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
youResearch for Residents A Primer

• 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

• 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

• 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
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VCUHS PD Resident Research Survey

• Financial support for travel to present research

Podium n Podium Poster n Poster
No 3 8 5 13
Mentor/Lab pays 1 3 1 3
lt 500 1 3 3 8
500-1000 9 23 11 28
Full cost 21 53 15 39
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VCUHS PD Resident Research Survey

• Research Resources mentorship
• Do you assign or does trainee select research
  mentor?
• Yes, assigned 5
• Yes, selected by trainee 33
• Project specific mentor(s) 59
• 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

• VCUHS Faculty Mentoring Guide 1997, 2002.

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Resident Research Mentorship
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Resident Research Innovations

• Mentoring Research teams
• 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.

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VCUHS PD Resident Research Survey

• What do you feel are the benefits of engaging
  trainees in research?
• Critical thinking, a less mechanistic approach
  to patient care.
• Appreciate the science behind what they do
  everyday.
• Increase programs strength. Attract academic
  oriented residents.
• Recognition of importance of three-legged stool
  of academic institution.
• Develop expertiseBecome content experts.
• Potential engagement in academic career.
• Career development, ability to attend meetings.

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VCUHS PD Resident Research Survey

• 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 mentormakes all the
  difference.
• More collaboration between departments.
• Pay for travel to present research.

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VCUHS PD Resident Research Survey

• What do you see as potential challenges to
  increasing trainee involvement in research?
• Time pressures of clinical care.
• increased clinical requirements with less time
  due to duty hours.
• Many have no interestif they plan to be
  clinicians full-time.
• 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.

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VCUHS PD Resident Research Survey

• Final comments, suggestions on resident research?
• 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.

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The Final Why?

• CASH
• AWARDS
• At VCUHS Resident Research Day

SHOWMETHE...MONEY!!
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VCUHS Resident Research Day

• 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

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VCUHS Resident Research Day
Depts/ Divs
2006 13
2007 13
2008 13
2009 11
2010 14
2011 19
Abstracts Submitted
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VCUHS Resident Research Day 2012

• Date Thursday June 7, 12 6 PM
• Place MMRB
• Abstracts Due Friday March 16th
• Abstract Format
• Structured Background, Methods, Results,
  Conclusions
• Word count 250 words or less
• Electronically submitted (email)

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Thank you!

• Questions, comments, discussion.