Teaching hospitals worldwide struggle with ways to support faculty and trainee scholarship. In the United States, inadequate documentation of attending and resident scholarly activity is a frequent citation by the ACGME.1 The Accreditation Council for Graduate Medical Education-International (ACGME-I) has also mandated that residents and faculty actively engage in scholarship.2 As such, international residency programs must develop methods to successfully incorporate research methodology training and facilitate scholarly activity.
Much of the medical education literature focuses primarily on resident scholarship, with limited information provided regarding faculty preparation or training for these initiatives. In 2002, Levine and colleagues3 surveyed 305 Internal Medicine program directors in the United States to describe how Internal Medicine residency programs fulfill the ACGME’s scholarly activity requirement. About half of the responding programs designated funds for resident and faculty scholarly activity, specifically funding for conference travel expenses, computer and technical support, administrative support, start-up costs for projects, and research assistants.
In a Dermatology residency program in Miami, Florida, research activity became a mandatory component for resident progression and graduation.4 With the support of a department research committee, teaching strategies included appointing a research mentor, providing assistance with project development and biostatistics, and providing the residents with multiple opportunities to present their work. The residents were also encouraged to submit a manuscript for publication. Since its inception, the program has substantially increased the number of resident publications.
Educators at Lincoln Hospital, an affiliate of Weill Medical College of Cornell University New York, designed and implemented a successful structured research curriculum based on ACGME competencies taught during a dedicated "research rotation."5 By appointing a qualified faculty member as a research director to assist faculty and residents with their projects, as well as providing on-line resources and a four-week block protected time for resident research projects, scholarly productivity improved at the institution.
Several of these studies5,6 revealed that a substantial amount of faculty effort was needed to increase residents’ research productivity. For example, an Internal Medicine Clinic Research Consortium was established by faculty in an ambulatory health center to supervise a resident-led research project.6 The initiative was successful, resulting in an award-winning poster presentation at a scientific meeting and publication in a peer-reviewed journal.6 However, the seven faculty members of this consortium described an ‘‘intense time commitment,’’ which they undertook without support, development or protected time.
Though many studies focus on trainee productivity, the literature also includes strategies for improving faculty scholarly productivity. For example, in the “Baby Steps” program developed at a small university-based Obstetrics program, the appointment of a mentored postdoctoral researcher was associated with improvements in both resident and faculty research activities.7 In the “Short Stops” program at New York Medical College, small groups of faculty scheduled hour-long meetings once every 4 to 6 weeks to define research questions, to brainstorm solutions for research barriers, to interpret already-collected data, and to read and edit each other's work.8 This peer mentoring program provided encouragement to fit scholarly activity into short stretches of time in busy schedules and succeeded in increasing participants’ research productivity. There was also an increase in mentoring of residents' research projects by the program participants.
A successful department-wide approach was recently described by Straus and colleagues.9 Faced with difficulties in recruiting clinician-investigators, a comprehensive faculty development initiative was developed to increase research productivity in a primary care department at the University of Minnesota Department of Family Medicine and Community Health (Twin Cities campus). At the onset of the program (in 1997), the department was clinically productive and graduated a significant number of students who pursued a career in primary care. However, only 10% of faculty time was spent on research activities and only 25% of the faculty were either tenured or on tenure tracks. A needs assessment, performed through surveys, focus groups and a faculty retreat, revealed faculty interest in research, but identified the need for mentoring, research methodology teaching and assistance in study design and data analysis.
The first step was to redefine the department’s mission to make research a priority and as important as education and patient care. A team of six tenured-faculty with extensive research experience, including a research director and associate, were identified through an internal search. These individuals became the leadership team for the initiative. The team also recruited a research writer/editor (PhD in basic science) and a statistician (PhD in educational psychology), whose roles were to teach a formal research overview course and to consult one-on-one with the faculty. A formal mentorship program was established for junior faculty. Grants and awards were made available for research activity. Also, research accolades were publicly acknowledged. Through these efforts, the team was successful in creating and sustaining a culture of leadership within the department, resulting in significant increase in grants and publications for faculty at all levels in their careers. This article provides practical recommendations that can be implemented in the international arena. By adapting several of these steps to the local context, it is possible that clinical departments worldwide could similarly develop a centrally coordinated faculty development initiative that provides training, technical resources, and activities aimed at building a scholarly culture.
Bowman and colleagues describe the successes at maintaining NIH funding for research at two Pennsylvania academic medical centers through an institutional commitment to excellence in both clinical and basic science research, particularly by supporting faculty advancement via funding, research administrative support and facility expansion.10 The authors conclude that increasing scholarly productivity rarely occurs in response to a single intervention, but is an institutional challenge that often requires multiple incremental changes and improvements.
The vast majority of published studies are US-based, with a glaring lack of literature from international teaching hospitals. In India, a study of over 300 interns was performed to assess learners' feedback on an educational intervention to provide hands-on learning experience in population-based research.11 Although over 70% of the participants rated their experience as positive, trainee satisfaction was the only measurable outcome of the study and there is no evidence of increased research productivity. In the United Arab Emirates, we developed and implemented a leadership-driven institution-wide initiative focusing on research methodology training and providing protected time and mentorship opportunities for research activities. Preliminary results have been quite positive, with significant increases in both resident and faculty research productivity.12
Academic medical centers worldwide strive to foster scholarship. Without a faculty that is knowledgeable and competent to perform high quality research, it is unlikely that trainee research productivity can be improved. Most studies focus on resident research initiatives with little mention of faculty development or support. Also, there are significant gaps in the literature regarding successful international initiatives. These remain important areas for future research.
- Beasley BW, Scrase DR, Schultz HJ. Determining the predictors of internal medicine residency accreditation: what they do (not what they say). Acad Med. 2002; 77:238–246.
- Accreditation Council for Graduate Medical Education International. Foundational program requirements IV.B.1. Available here Accessed July 22, 2014.
- Levine RB, Hebert RS, Wright SM. Resident research and scholarly activity in Internal Medicine residency training programs. J Gen Intern Med. 2005; 20:155-159.
- Kirsner RS, Kerdel FA, Falanga V, Trent J, Eaglstein WH. The role of mandated research during dermatology residency training. J Invest Dermatol. 1999; 112:400–401.
- Kanna B, Deng C, Erickson S, Valerio J, Dimitrov V, Soni A. The research rotation: competency-based structured and novel approach to research training of internal medicine residents. BMC Med Educ. 2006; 6:52. Available here
- Internal Medicine Clinic Research Consortium Faculty. Housestaff team research in the ambulatory setting: it can be done. J Gen Intern Med. 1995; 10:219–222.
- Penrose L, Yeomans E, Praderio C, Prien S. An incremental approach to improving scholarly activity. J Grad Med Educ. 2012; 4(4):496-499.
- Edwards K. ‘‘Short stops’’: peer support of scholarly activity. Am Med. 2002; 77(9):939.
- Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Acad Med. 2013 Jan; 88(1):82-89.
- Bowman MA, Rubenstein AH, Levine AS. Clinical revenue investment in biomedical research: Lessons from two academic medical centers. JAMA. 2007; 297:2521–2524.
- Chaturvedi S, Aggarwal OP. Training interns in population-based research: learners’ feedback from 13 consecutive batches from a medical school in India. Med Educ. 2001; 35:585–589.
- Ibrahim H, Nair SC. Focus on international research strategy and teaching: the FIRST programme. Persp Med Educ. 2014; 3(2):129-135.
Reviewed for september by
Halah Ibrahim MD MEHP FACP
Founding Designated Institutional Official
Abu Dhabi, UAE