EASE: Engaging Residents in Research

1. EASE: Engaging Residents in Research Evan R. Reiter, MD, FACS Program Director, Vice Chair Dept of Otolaryngology – Head & Neck Surgery

2. 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.

3. Research in Residency Why? What? How? Why? (yes I know, again)

4. 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)

5. “Why do I need to do research if I’m 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.

6. 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]

7. 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.”

8. 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.

9. Residency Research: Key Ingredients Time Training Facilities Mentorship Motivation/Incentives?

10. 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 %)

11. 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

12. Research and the Core Competencies Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information andcollaboration 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,

13. Research and the Core Competencies Medical Knowledge Residents must demonstrate knowledge of established andevolving biomedical, clinical, epidemiological and social-behavioralsciences, 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 scientificevidence, 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;

14. Research and the Core Competencies:Documentation 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

15. Research and the Core Competencies:Documentation Semi Annual Review Summary

16. 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: < 6 mo, 1: 6-11.9 mo, 3: > 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)

17. VCUHS PD Resident Research Survey • Approximately what percentage of your trainees get involved in some form of research?

18. 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.

19. 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.

20. 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 %

21. VCUHS Research Training VCU ORSP: http://www.research.vcu.edu/orsp/index.htm 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

22. VCUHS Research Training VCU ORSP: Animal Subjects: https://www.vcu.edu/research/iacuc/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

23. 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.

24. CCTRCore Units of the Center • Research Incubator • Research Education and Training • Community Engagement and Research • Participant and Clinical Interaction Resources • Biomedical Informatics

25. 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@vcu.edu http://www.cctr.vcu.edu/research_incubator/index.html

26. Research Education and TrainingPrograms Available CCTR Educational Platform Postdoctoral Mentored (K12) C/T Master’s and Doctorate Program C/T Scientist Certificate Program Clinical Investigator Core Program

27. 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

28. Research Education and TrainingPrograms Available • Clinical and Translational Sciences Certificate • Open to students, staff, faculty, community-based clinicians, professional research associates, and coordinators • Master’s and Doctorate in Clinical and Translational Sciences • Competitive application process • Strong focus on interdisciplinary clinical and translational research

29. Coming soon to a conference room near you…“Research 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.

30. 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

31. Research resources: funding sources VCUHS PD Resident Research Survey

32. Financial support for travel to present research: VCUHS PD Resident Research Survey

33. 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%

34. Resident Research: Mentorship • VCUHS Faculty Mentoring Guide 1997, 2002.

35. Resident Research: Mentorship

36. 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.

37. 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 program’s strength. Attract academic oriented residents.” • “Recognition of importance of three-legged stool of academic institution.” • “Develop expertise…Become content experts.” • “Potential engagement in academic career.” • “Career development, ability to attend meetings.”

38. 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 mentor…makes all the difference.” “More collaboration between departments.” “Pay for travel to present research.”

39. 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 interest…if 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.”

40. 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.”

41. The Final “Why?” SHOW…ME…THE...MONEY!! CASH AWARDS At VCUHS Resident Research Day

42. 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

43. VCUHS Resident Research Day Abstracts Submitted

44. 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)

45. Thank you! • Questions, comments, discussion….