Resident participation in scholarly activity is essential to increase levels of satisfaction with residency training, growth of our profession, and promote evidence-based medicine.1–3 The Accreditation Council for Graduate Medical Education (ACGME) requires every resident to complete an academic assignment.a However, the type of assignment is not clearly defined, ranging from a grand rounds presentation to a book chapter or peer-reviewed article. Based on the ACGME requirements, beginning with the graduating class of 2010, we instituted a program in which every resident completes a resident academic project (RAP). The expectation is that each RAP results in a manuscript of publishable quality. We describe in this article our successful implementation of a structured RAP program.
At the Penn State Hershey Medical Center, we implemented the RAP program beginning with the graduating class of 2010.
RAPs considered suitable included clinical investigations, basic science studies, or an education, quality improvement, or simulation project. Alternatively, a scholarly analysis of a clinical case report or a review of sufficient depth to allow submission as a book chapter or review article was considered a suitable project. We provided our residents a bank of feasible projects, solicited from our faculty, on the departmental research Web site. In addition, we encouraged our residents to suggest projects of interest.
We established a resident project oversight committee (RPOC) consisting of 6 attending anesthesiologists, headed by a residency project director. The RPOC reviews and approves all projects. The RPOC also reviews RAPs in progress and assists with overcoming barriers/obstacles to progress.
We defined a timeline for all steps in the project, coordinated with progression of each resident through the training program.
Year 1 of Residency
(Year 1 is defined as postgraduate year-1 for the 4-year program and postgraduate year-2 for the 3-year program.)
- The residency project director, together with the vice chair for research, assists the resident in establishing an academic project team comprising the resident, a mentor (either an associate professor or a full professor), and an advisor (typically junior faculty).
- The resident identifies a project of interest.
- The resident writes an academic project proposal (in the style of a “specific aims” page for a grant proposal), which is reviewed by the resident’s mentor and advisor. After their approval, the resident submits the proposal to the RPOC by April 1 for approval. The proposal is reviewed by the RPOC for value and feasibility before the resident begins work on the project.
Year 2 of Residency
The resident, with the aid of the academic project team, completes the project. All residents in the 4-year program are allowed to choose an elective rotation for research to have dedicated time to work on their projects. Additional academic time for research is adjudicated by the RPOC based on the validity of the individual request.
Year 3 of Residency
- By May 1, the resident reports the results to the RPOC in the form of a publishable manuscript. The manuscript must be written in the format required for publication in a leading journal in the field of anesthesiology. We recommend using the templates available from the International Anesthesia Research Society’s journal, Anesthesia & Analgesia.b Members of the RPOC evaluate the manuscript and determine whether it is satisfactory for successful completion of the project. The resident must revise the manuscript until it is judged satisfactory by the RPOC.
- The resident prepares a 10-minute presentation to be given at the Anesthesiology Department Grand Rounds in May/June. Associate professors and professors of anesthesiology in the department are requested to complete a scoring sheet (Table 1) to evaluate the presentation. An average score ≥5 is necessary for satisfactory completion of the project.
The following resources are available to residents to ensure they have a positive and productive research experience.
The department of anesthesiology’s research specialist is available to assist residents with all phases of the project, including designing the study, writing the research proposal, analyzing results, and preparing the manuscript. The research specialist prioritizes her time based on the research need. Resident research needs are as much a priority as are those of faculty members and residents receive as much assistance as required. Statistical advice related to study design and data analysis is available through the Biostatistics and Bioinformatics Research Collaboration and Consultation Service of the Penn State Hershey College of Medicine Department of Public Health Sciences. A research coordinator in the department of anesthesiology is available to assist the research team with preparation of the application if IRB approval is necessary for the study. The Penn State Hershey College of Medicine provides the Health Insurance Portability and Accountability Act-compliant Research Electronic Data Capture (REDCap) application to aid in collection and storage of study data.4 REDCap is maintained by the REDCap Consortium,c of which Penn State University is a member. A research technologist in the department of anesthesiology is an expert in the use of REDCap and provides training and support for departmental users including residents working on their academic projects.
The resident may request funding support for the project through the Department of Anesthesiology’s Resource Allocation Committee. This support allows residents to choose projects that have a cost involved, as long as the project is deemed to be meritorious, feasible, and scientifically sound. Accurate documentation of proposed costs for components of the research project is required. Documentation of money spent, progress reports, and a final report on the outcome of the project at the end of the funding period (usually 1 year) are also required as conditions of this funding.
Research teaching sessions are conducted annually for all residents as a part of their curricular education. These include research methodology, epidemiology, design of research studies, data and descriptive statistics, ethics in research, and learning how to critically review a journal article. Regardless of the type of project chosen, residents are required to complete the Collaborative Institutional Training Initiative Program’s course “Human Subjects Research.”d In addition, monthly research review meetings serve as a forum to discuss research project designs, progress and results, and receive critical feedback from faculty.
Pennsylvania Anesthesiology Resident Research Conference
The Pennsylvania Anesthesiology Resident Research Conference was established in 2007 to increase resident research interest. It is an annual meeting held in May of each year and hosted, by rotation, by one of the academic medical centers in Pennsylvania. Three prizes are awarded for each category of presentation: original research oral presentation, original research poster presentation, case report oral presentation, and case report poster presentation.
We now have 4 years of experience with this structured program. During this period, all 69 residents who graduated from the residency program successfully completed their research projects. Faculty participation has been robust, with all the anesthesiology professors and associate professors serving as mentors for at least 1 resident project. More than 50% of assistant professors and instructors have served as advisors for the projects. RAPs have included performing clinical and basic science studies, preparing and publishing case reports, and writing literature reviews on the current and historical topics of interest. In addition, residents have conducted quality improvement projects, designed teaching modules for resident education, and completed projects on the use of simulation in anesthesiology (Table 2).
Departmental support resources were well used. All residents were assisted by the research specialist. Ten residents sought statistical advice from the Department of Public Health Sciences. Nineteen residents used the services of the research coordinator. Twelve residents requested and received funding (an average of $4664) through the Departmental Resource Allocation Committee. Forty of the 42 residents enrolled in the 4-year program chose an elective research rotation and had dedicated time to devote to their projects.
One measure used to assess the scholarly activity of our anesthesiology residents is the number of peer-reviewed publications achieved (Table 3). The tabulation of publications authored by Penn State Hershey Medical Center anesthesiology residents includes any publication based on research conducted during the residency, whether or not that research was part of the project to satisfy the ACGME academic assignment requirement. The time to publication of manuscripts can vary widely depending on the quality of the submission, the peer-review process of the journal, and, of course, on the persistence of the authors. The final number of publications attributed to a specific resident graduation class could continue to increase after graduation. The types of projects represented by the residents’ publications are detailed in Table 2.
On average, 32% of residents participating in the structured research program (graduating classes of 2010–2013) have co-authored peer-reviewed publications. There are, on average, 9 resident-authored papers published by each resident class (Table 3). In addition, an average of 9 residents presented annually at the regional Pennsylvania Anesthesiology Resident Research Conference. Resident presentations at annual national conferences have increased from 6 in 2010 to 16 in 2013. These data represent a marked increase in the number of residents publishing, number of manuscripts published, and resident participation in regional and national anesthesiology conferences compared with the resident classes of 2007 to 2009, when residents were not required to participate in a structured RAP program (Table 3). Of the 69 residents in the 2010 to 2013 graduating classes, 46% chose to continue study through a fellowship or entered an academic career. Before the RAP program was instituted, for the classes of 2007 to 2009, 36% of residents chose to continue study through a fellowship or entered an academic career. The percentage of residents who published manuscripts based on their resident research increased after the implementation of the structured research program, regardless of the career path chosen (Table 4).
The results of our RAP program are consistent with previous reports in anesthesiology, and other medical specialties showing that a structured resident research program increases research productivity.1–3,5 In a recent survey of anesthesiology residency program directors, a >20% publication rate for trainees in programs with a structured research curriculum was reported.1 As an additional incentive to participate in research, the department provides $1000 annually for 3 resident research awards.
Several obstacles to research during residency have been reported. These include limited research time for faculty and residents, insufficient interest, lack of faculty participation, insufficient resident research skills, inadequate funding, and lack of research curriculum.6 Limited protected time for research is a common problem in many institutions and is a well-known barrier for scholarly productivity.5,7,8 We found the same obstacles related to time constraints and resident interest in research but found that the resources provided by the department of anesthesiology encouraged faculty participation and provided residents with necessary research skills, training, and funding to successfully complete a research project. Faculty enthusiasm and interest in research has appeared to promote the same in residents, and faculty participation in research has also increased with the implementation of the structured RAP program. Faculty members have stated that the support resources provided by the department have allowed them to increase their participation in resident research.
Although only 3 basic science projects were undertaken to fulfill the academic project requirement (probably because of the greater time commitment required), all resulted in publications. Prospective, randomized clinical studies also require an extensive time commitment for successful completion. That difficulty is reflected in the lower rate of publication for the clinical study projects (7 publications from 23 projects). Simulation studies also demonstrated a low publication rate (3/15). Case reports were a popular project type and demonstrated a high publication rate (9/16), possibly because the RPOC only approved cases that demonstrated specific teaching points likely to merit publication.
The RPOC closely monitors the selection of realistic projects that can be successfully completed in the time available. However, Ahmad et al.1 found no correlations between the publication rate and the research rotation of >2 months. Our findings are similar to the latter study because we only offered a 1-month elective research rotation. We also experimented with instituting “academic research Fridays,” but this did not increase research participation and was discontinued.
For our 2010 to 2013 resident cohorts, for whom participation in the RAP program was mandatory, almost half (46%) chose to complete a fellowship and/or pursue an academic career. That is more than the 36% of residents from the 2007 to 2009 classes who chose that path, and in our experience with many years of resident education, is a very high number. Although many factors influence residents’ career choices, it is our hope that this presages a continued interest in academic careers and that it represents a positive outcome of our RAP program.
To further develop the academic potential of our residents, beginning with the graduating class of 2018 (entering class of 2015), our department will offer a research-based scholarship for 1 resident per class. The scholarship recipient will make an extensive commitment to research and will be granted protected time for research (up to the ACGME allowance of 6 months over the 4-year residency), as well as additional financial support. This scholar will be expected to complete a formal research project and a graduate certificate program in clinical research or translational science.
We believe that the apparent success of our RAP Program is because of the following:
- Definition of a clear timeline for all steps in the project;
- Establishment of a RPOC to assist residents in choosing feasible projects and to continually monitor progress and intervene, if necessary, to avoid major pitfalls;
- Strong anesthesiology faculty participation; and
- Provision of a support team and necessary infrastructure to foster an environment that promotes successful research experiences.
We believe that this structured RAP program has helped grow the academic potential of our anesthesiology residents and helps train future academic anesthesiologists.
a ACGME Program Requirements for Graduate Medical Education in Anesthesiology. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/040_anesthesiology_07012014.pdf. Accessed October 27, 2014.
b Anesthesia & Analgesiajournal’s manuscript templates are available at: http://edmgr.ovid.com/aa/accounts/ifauth.htm. Accessed October 27, 2014.
c Information about the REDCap consortium is available at: http://project-redcap.org/. Accessed October 27, 2014.
d Information on the Collaborative Institutional Training Initiative Program’s course on Human Subjects Research is available at: https://www.citiprogram.org/index.cfm?pageID=88. Accessed October 27, 2014.
1. Ahmad S, De Oliveira GS Jr, McCarthy RJ. Status of anesthesiology resident research education in the United States: structured education programs increase resident research productivity. Anesth Analg. 2013;116:205–10
2. Sakai T, Emerick TD, Metro DG, Patel RM, Hirsch SC, Winger DG, Xu Y. Facilitation of resident scholarly activity: strategy and outcome analyses using historical resident cohorts and a rank-to-match population. Anesthesiology. 2014;120:111–9
3. Takahashi O, Ohde S, Jacobs JL, Tokuda Y, Omata F, Fukui T. Residents’ experience of scholarly activities is associated with higher satisfaction with residency training. J Gen Intern Med. 2009;24:716–20
4. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81
5. Levine RB, Hebert RS, Wright SM. Resident research and scholarly activity in internal medicine residency training programs. J Gen Intern Med. 2005;20:155–9
6. Rothberg MB. Overcoming the obstacles to research during residency: what does it take? JAMA. 2012;308:2191–2
7. Crawford P, Seehusen D. Scholarly activity in family medicine residency programs: a national survey. Fam Med. 2011;43:311–7
© 2016 International Anesthesia Research Society
8. Rivera JA, Levine RB, Wright SM. Completing a scholarly project during residency training. Perspectives of residents who have been successful. J Gen Intern Med. 2005;20:366–9