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A Consortium-based Research Education Program for Residents

Neale, Anne Victoria PhD, MPH; Pieper, David PhD; Hammel, Ernest PhD

EDUCATING PHYSICIANS: ESSAYS
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With growing pressures to consolidate and reorganize health care delivery systems, graduate medical education (GME) consortia can draw faculty from affiliated members to assemble educational programs. The authors report on consortium-based research education seminars of a quality that many residency programs would be unable to develop and support on their own. Drawing a diverse faculty from consortium members and area universities, the OHEP Center for Medical Education's annual Research Workshop Series focuses on the design of research projects; data analysis and hypothesis testing; and written and oral presentation of scientific research. Each spring, OHEP sponsors a research forum in which the best research projects from consortium members are presented by the resident—researchers, who compete for recognition and prize money. Further, of the 128 presentations made thus far at the annual OHEP Research Forum, 25% were subsequently published. The consortium's research education program has been well received by residents, is cost-effective, and is an integral component of the research curricula of many area residency programs. Including research training in GME provides residents an opportunity to become more competitive for fellowship, faculty, and leadership positions.

Dr. Neale is associate professor, Department of Family Medicine, Wayne State University School of Medicine, Detroit, Michigan; Dr. Pieper is director, GME Biomedical Investigations and Education Programs, St. John Hospital, Detroit, Michigan; and Dr. Hammel is executive director, OHEP Center for Medical Education, Southfield, Michigan.

Correspondence and requests for reprints should be addressed to Dr. Neale, Department of Family Medicine, Wayne State University School of Medicine, 4210 St. Antoine, Suite 4-J, Detroit, MI 48201; e-mail: 〈vneale@med.wayne.edu〉.

Presented in part at the Innovations in Medical Education Exhibit of the Annual Meeting of the Association of American Medical Colleges, New Orleans, LA, November 1998.

The following members of the OHEP Research Committee contributed to the development and success of the Research Workshop Series: Mohan Chelladurai, PhD, Providence Hospital, Southfield, Michigan; Adhip Majumdar, PhD, Veterans Administration Medical Center, Detroit, Michigan; Ruth Moore, PhD, Oakwood Hospital, Dearborn, Michigan; Andrew Saxe, MD, Sinai—Grace Hospital, Detroit, Michigan; Allen Silbergleit, MD, PhD, St. Joseph Mercy Oakland, Pontiac, Michigan; and Yvan Silva, MD (Chair), North Oakland Medical Centers, Pontiac, Michigan.

Research education is a fundamental aspect of resident training, one in fact required by the Accreditation Council of Graduate Medical Education. In order for residents to design, conduct, and present their research studies, they need training in literature searching, research design and methods, statistical analysis, data management, medical writing, and presentation skills.1,2 Thus, adequate research training requires broad faculty expertise, which may be difficult for individual residency programs to support. The recent reductions in funding for graduate medical education (GME) have also hampered the ability of residency programs to deliver comprehensive training in how to conduct research. In spite of these pressures, it remains important to prioritize research training and emphasize the scientific basis of medical practice.3,4,5

Medical education consortia involving academic health centers, community hospitals, and other health care organizations are a strategy for delivering high-quality educational programs while constraining costs.6 A medical education consortium can draw faculty from its affiliated members to assemble educational programs with a broader scope and depth than would be possible at individual member sites. Consortium-delivered research education programs may be particularly beneficial for community hospitals with GME training programs.7

The OHEP Center for Medical Education (OHEP) was incorporated in 1974 as the “Oakland Health Education Program” and is based in Oakland County, Michigan.6 Since its inception, OHEP has grown into the southeastern Michigan regional consortium (which is now commonly referred to as the Wayne State University (WSU)-OHEP Medical Education Consortium). Its membership currently includes the WSU School of Medicine, the seven WSU-affiliated Detroit Medical Center hospitals, and six community teaching hospitals. OHEP's primary mission is to promote delivery of good health care through excellence in medical education. In addition to its annual Research Workship Series, OHEP conducts medical education activities in family practice, internal medicine, surgery, obstetrics-gynecology (ob-gyn), psychiatry, and behavioral medicine. It offers a wide range of programs, including oral examinations, board review courses, faculty development, and educational technology courses.

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OHEP'S RESEARCH EDUCATION PROGRAMS

The OHEP Research Committee is the organizing body for the OHEP research education program and meets monthly. The committee is composed of two representatives from each consortium member institution. The committee includes residency program directors, clinical and basic science researchers, and research educators. Since 1982, the OHEP Research Committee has delivered an annual workshop series with the objective of teaching residents research methods and presentation skills. The committee also sponsors the OHEP Research Forum, a regional research competition described below.

Members of the committee, in accordance with their interests and expertise, teach the annual research workshop sessions. In addition, paid expert lecturers occasionally are invited to make presentations in study design, biostatistics, scientific writing, and other topics. Presentation methods used by the faculty vary according to the materials presented and include lecture, seminar discussion, and workshop development of residents' research projects.

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OHEP's Research Workshop Series

The research workshop series consists of four half-day sessions intended to help prepare residents to meet their research requirement, from project inception to presentation at their hospital's annual research day competition. Each seminar is presented on a Wednesday afternoon, and includes lunch.

Residents from all member hospitals participate in the workshops. They come from all specialities, although most are from family practice, internal medicine, ob-gyn, and surgery programs. Residents come from all levels of training, first through fifth year. Most residency directors support the workshops and urge their residents to attend, particularly those residents without medical school research experience.

An outline of the content of the 1998–99 workshop series is shown in List 1. Workshop I, “Design of Research Projects,” is held each autumn and emphasizes the value of research training for evidence-based clinical practice. This workshop focuses on developing research questions, operational definitions, study designs, and data-collection methods. Residents are encouraged to apply these concepts to their own areas of interest, and are asked to volunteer topics as examples for discussion.

List 1

List 1

Workshop II, “Data Analysis and Hypothesis Testing,” is held one month later, and provides an introduction to statistical methods and how they are used in analyzing research data. The use and application of sampling procedures and statistical tests are the primary focus of the seminar. Analysis and interpretation of data from research studies are demonstrated using statistical software. Again, residents are encouraged to explore the application of basic statistical concepts to their own research questions.

Workshop III, “Written and Oral Presentations of Scientific Research,” focuses on writing abstracts; preparing reports for publication; and using visual materials in oral and poster presentations. This seminar is of particular interest to graduating residents preparing presentations for their hospitals' research days.

The above three workshops constitute the core of the research workshop series. Workshop IV focuses on varying topics. For example, we have provided an opportunity for residents to receive a critique of their upcoming researchday oral presentations, as well as seminars on outcomes research, using the Internet in research, and most recently, evidence-based medicine.

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Hospital Research Days

Each OHEP member hospital sponsors an annual research day where residents present their research studies. Although the institutions vary the formats of their research days, typically these are halfday events in the spring of each year. Usually the residency program directors recommend their best two or three resident research projects, and panels of outside clinician—scientists and researchers serve as judges, scoring both the presentation of each study and its scientific aspects. The residents presenting the best papers at the individual hospital research days are then invited to present their projects and compete for prize money and regional recognition at the annual OHEP Research Forum.

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OHEP Research Forum

The OHEP Research Forum is a oneday regional research competition held each May. A panel of four judges, each from an area university, uses a structured judging form to select the best three presentations. The names of the winning residents and their research projects are announced a few weeks later in an awards ceremony at the OHEP Meadow Brook Lecture. The lecture is an annual dinner event with a distinguished lecture presented by an internationally recognized research scholar.

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EVALUATION DATA AND COSTS

The contents of the workshops and the evaluation system have changed over time, so we present here the evaluation data for the 1994–1998 workshops. During these five years, a mean of 62 residents attended each of the three core research workshops. Residents' evaluations of the workshops over these five years were moderately positive. Mean ratings ranged from 3.8 to 4.3 on a five-point Likert scale, where 5 is the highest rating. The periodic revisions of the curriculum make it difficult to longitudinally evaluate the specific content of each workshop. Although we collect evaluations at each workshop, we have not conducted a follow-up survey regarding the value of the OHEP Research Workshops to practicing physicians who attended the workshops during their residency.

To determine the number of papers presented at the OHEP Research Forum that were subsequently published in Medline-indexed journals, we assembled a list of all study titles that were presented at the Forum from 1988 (the first year of the Forum) through 1996 and the names of the residents who presented them. Then we entered up to two author names or an author name and a keyword into a Medline search. We identified 32 publications from the 128 that were presented. Surgery residents made the most Research Forum presentations (47) and published 38.3%; ob—gyn residents had the highest publication rate, at 43.2%. The overall publication rate compares favorably with Heinrich et al.'s report that 21.5% of 65 presentations at a community teaching hospital were subsequently published7; in addition, the 43% publication rate for ob—gyn residents approaches the 50% success rate over ten years reported by Morrison et al.8. These publication rates are likely to be underestimates because of failure to identify all subsequent publications and those in journals that are not indexed in Medline.

OHEP member institutions can send all interested faculty and residents to the Research Workshop Series without paying individual registration fees. Residents from non-member institutions pay $30 per resident per workshop or $75 for the core series of three workshops. The total expenses (honoraria, printing, postage, typesetting, supplies, and meals) for the 1996–1998 workshop series averaged $3,400 per year. The total revenue (registration fees and pharmaceutical sponsor contributions) during the same three-year period averaged $1,272; member institutions equally shared the remaining average annual cost of $2,128.

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DISCUSSION

Educating residents in the conduct of research can promote excellence in patient care and provide essential skills for lifelong learning. It should enhance analytic reading skills and critical thinking and it can prepare graduates for various research roles in academia and the community.9 Although some residency program directors have expressed concern about the feasibility of collaborative GME,10 there are many advantages to the consortium approach to teaching research methods.6 Most notably, the pooling of consortium members' talent and resources yields a high-quality teaching program that many residency programs would be unable to develop and support on their own. In addition, the breadth of the faculty expertise and the depth of the research curriculum are advantageous for resident recruiting and program accreditation. The OHEP consortium also promotes resident research and collegial dialogue through a regional competition that provides residents with an opportunity for sharing expertise, networking with colleagues, and developing collaborative projects.

Residents are most enthusiastic about the workshops when they include some type of interactivity. We have found several approaches to be useful. Breaking into small groups to refine general research topics into feasible and specific research questions is one strategy. Another is the use of a case study to demonstrate the research process and elicit audience participation in designing a feasible method. Recently we introduced the use of interactive keypads to rapidly collect and summarize audience responses to the preferred study design or statistical analysis of specific case examples.

There are limitations to the workshop approach. First, a great deal of material must be compressed into each of the half-day research workshops; however, residents receive a folder with the presentation materials for future reference. Second, although it is desirable for residents to receive the workshop information in tandem with the progression of their own research study, this individualized approach is left to each program's faculty. The committee does contribute individualized support by providing residents with a directory of resource people (committee members, workshop speakers and others) who can help them with their projects.

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FUTURE DIRECTIONS AND CONCLUSION

The newest project of the OHEP Research Committee is a competitive grant program with the objectives of facilitating collaborative research among members of the consortium, promoting scholarly activity by residents and faculty, and promoting use of community hospital resources for research endeavors. Funding for the OHEP—WSU Partnership Grants Program is provided by a research fund supported by contributions from consortium members and outside sources. Research in any area of medicine is considered for funding up to $10,000 each year. All projects must involve two or more institutions of the OHEP consortium, and at least one investigator must be a physician in training. The first award was made in 2000.

Consortium member institutions take turns hosting the workshops, so travel times for the attending residents vary. To make the workshops more accessible, in the future we plan to use distance-learning technologies to broadcast them via video-conference.

Offering training in research is a pre-requisite to promoting scholarly activity in the GME setting. It provides residents with the stimulus to develop critical appraisal skills and to acquire habits of intellectual curiosity and life-long learning. The skills of systematic inquiry also offer the graduating physician the means to analyze his or her patient population, and thus develop strategies to optimize quality of care. In addition, including research training in GME provides residents with an opportunity to become more competitive for fellowship, faculty, and leadership positions.

The OHEP Research Workshop Series, which is an integral component of the research curricula of many area residency programs, benefits from its consortium context. First, the consortium affiliation allows the research committee to draw the best possible faculty from both member and nonmember institutions; second, the consortium provides broad expertise in developing the research education curriculum; and finally, the consortium's sponsorship of the annual seminar series ensures optimal cost—effectiveness in this era of diminishing educational resources.

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REFERENCES

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2. Holloway RL, Altemeier TM. A comprehensive research program for family medicine residents. Fam Med. 1986;18:133–5.
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4. Cohen JJ. Medical education and the shifting constructs in health care. Acad Med. 1995;70:824.
5. Weiss BD. The death of academic family medicine: can it be prevented? Fam Med. 1995;27:139–42.
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7. Heinrich G, Nori D, Tome J, Parikh S. Developing a research program in a community teaching hospital. Teach Learn Med. 1999;11:89–93.
8. Morrison JC, Meeks GR, Martin JN, Cowan BD, Whitworth NS, Wiser WL. Resident research projects: frequency of presentation and publication in a national forum. Am J Obstet Gynecol. 1994;170:777–81.
9. Alguire PC, Anderson WA, Albrecht RR, Poland GA. Resident research in internal medicine training programs. Ann Intern Med. 1996;124:321–8.
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