Many articles failed to report steps essential to curriculum development. Twenty-seven articles (66%) reported curricular objectives (see Table 2). The most common objectives were to increase house officers' research productivity and improve their critical appraisal skills. Two residency programs developed curricula to meet the ACGME scholarly activity requirements. Only one curriculum was designed with the goal of producing academic physicians.64 Eleven articles (27%) documented needs assessments. The methods employed included holding planning sessions attended by educators and researchers,31,32,35,49 literature reviews,37,52,66,68 and surveying residents about their interests and skills.34,43,44
Most curricula used multiple educational strategies (see Table 1). Common methods used were conducting research projects, exposing learners to research mentors or role models, and providing house officers with multiple opportunities to present their work, often at seminars or “research in progress” sessions. In many programs, residents were expected to present their final work at departmental (e.g., research day, grand rounds), regional, or national forums,21,24,26,27,31,32,33,34,36,39,40,41,42,43,47,48,50,51,52,67,69, 70,72 or submit a manuscript for publication.29,39,40,41,43,45,69,72
Whereas most research curricula were integrated as longitudinal components of the residency curriculum, a few were scheduled in dedicated blocks of time (range: two days to four months).23,24,27,35,41,49,50 Twenty-two programs had a required curriculum20,21,24,26,27,29,32,34,35,36,39,41,42,43,47,49,50,51,66,67,70,72 and 16 offered protected time to work on research projects21,22,24,26,27,29,31,32,36,43,49,50,51,52,68,69 (range: one to nine months).
Many unique educational strategies were used to teach house officers. In four programs, the research curriculum was mandatory but a research project was not.26,34,35,66 In contrast, Lambert describes an informal, mentor-based research program without lectures or seminars for only those residents interested in research. Learners were paired with mentors who guided the house officers in all phases of a research project.68 The Internal Medicine Clinic Research Consortium Faculty reported that 66 second- and third-year residents worked together on a single project.40 At another program, upper-level residents acted as principal investigators on projects. Portions of a research project were assigned to junior residents at the discretion of the principal investigator.46 Other distinct strategies included offering academic coursework,20 master's degree credit,39 and requiring residents to do multiple research projects.36 Neale described a consortium composed of community- and university-affiliated hospitals as well as a medical school whose goal was to assemble educational research programs with broader depth than might be possible at individual sites.48
Evaluation Methods and Outcomes
The evaluation of learners was often sparse, frequently limited to authors' anecdotal reports or learners' self-assessments of their knowledge, skills, or satisfaction (learners were generally described as having increased their knowledge or skills and being satisfied with the research experience). Only five articles (12%) described objective pre- and post-intervention testing of knowledge.23,35,41,52,66 All post-intervention testing was done immediately after the curriculum; none of the reports included long-term follow up. No curriculum was evaluated as a prospective pretest—posttest controlled trial.
Twenty programs described the success of their house officers in having research accepted for presentation at regional or national meetings and in publishing their research.21,24,25,28,31,32,33,35,36, 40,42,43,46,48,49,51,52,67,68,72 Nine articles compared house officers who had participated in the curriculum with those who had not. Five reported increases in their quantity and/or quality of residents' research.32,35,37,68,71 Gaspar and Ely and Fraker et al. reported that, prior to implementing their curricula, zero and 19% of their house officers, respectively, had participated in research. After implementation of the curricula, the percentages increased to 75% and 100%.31,41 Kirchner et al. described an increase in residents' presentations at national conferences.72 Rydman et al. reported that within four months of completing the program, 76% of house officers had submitted National Institutes of Health grant proposals, versus 23% the preceding year.39 Five articles stated that faculty research productivity had increased as a result of the residents' research curricula.28,31,32,35,41
Sustainability and Feasibility
In the articles, curricula had been in place a median of five years (range one to 18 years) and had attracted relatively few participants since implementation (median 20, range four to 800; see Table 1). The articles revealed that faculty effort needed to increase residents' research may be substantial. The seven faculty members of the Internal Medicine Clinic Research Consortium described an “intense time commitment.”40 Lambert and Garver state that mentors must “extensively” involve themselves in residents' projects.68 More specifically, Alguire et al. delineated the time commitment of a research director as “10–20% of a full-time position.”52 Costs were described as minimal or modest.32,47,71 Wilson and Redman reported that each resident was given $200 to complete his or her project.70 Alguire and Neale stated that their programs had annual budgets of $3,000 and $7,000, respectively.48,52 In articles where this information was available, the numbers of faculty involved ranged from two to seven.37,39,40,66
Rare mention was made of the barriers encountered in implementing curricula. Obstacles were often described in general terms (see Table 3), and the few curricular modifications reported were nonspecific. General statements described modifications or periodic revisions of curricula,29,48,52,70 such as “the course is modified based on feedback from students and instructors,”23 and “the program was piloted and improved.”50 Clayton and Sheldon-Keller were more specific, stating that residents' dissatisfaction with the structure of the research project had led to changes in the research requirement.66
The published curricula represent a diverse group of educational interventions designed largely to increase house officers' scholarly productivity, develop critical appraisal skills, and give residents an appreciation for research. Common educational strategies include lectures and seminars, having residents perform a research project, learning from role models and mentors, and providing house officers with multiple opportunities to present their work. Information about the curriculum development process, evaluation methods, and outcomes was often limited.
Completing a research project during an already busy experience is challenging. Factors consistently described in the literature as being necessary for successful research training include (1) exposure to and guidance from mentors, (2) training in basic research methods, (3) protected time, and (4) an environment supportive of research.75,76,77 We found many of these elements incorporated in the reviewed curricula.
Despite this, most curricula lacked key information for critical review by educators. Many reports provided incomplete descriptions of program and learner characteristics, instructional strategies, sustainability, and feasibility. Needs assessments, articulation of clearly defined learning objectives, and evaluations were also frequently missing. These are important to perform and document for many reasons. A curriculum developed without a needs assessment risks inefficiency or ineffectiveness. Unnecessary resources may be devoted to areas learners have already mastered and insufficient resources devoted to areas of particular need.17 Measurable objectives further refine curricular content and help guide the selection of educational and evaluation methods.78 Evaluations provide information useful for improving the performances of individuals and programs.79. In addition, evaluation results can be used to maintain support for a curriculum, document the accomplishments of learners and developers, and serve as a basis for garnering funding. To the extent that a curriculum addresses an important need or introduces novel educational strategies, evaluation results may be of interest to educators from other institutions.17 Finally, reports lacking curricular elements can hinder educators interested in adopting curricula.80
Several limitations of our study should be considered. First, we limited our search to published curricula. Clinician educators may not rely on a national reputation for promotion and may be less inclined to publish their curricula. Other curricula likely exist but are not readily available to educators interested in modifying them for their own needs. Second, we may have missed some published curricula. To minimize this, two investigators independently performed a literature search using a strategy developed with the aid of a medical librarian.
Residents' research curricula teach house officers how to articulate clinical questions, appraise the literature, apply research skills, and work with mentors. As such, these educational interventions have great potential to impact learners and increase scholarly activity. Curriculum developers have an obligation to use established principles and report reliable and meaningful outcome evaluations so learners and educators can maximally benefit from their efforts.
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