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Education and Administration Article

PHYSIATRIC RESEARCH FELLOWS' PERCEPTIONS OF THE QUALITY OF THEIR TRAINING1

DeLisa, Joel A. MD, MS2; Jain, Sudesh Sheela MD; Kirshblum, Steven MD

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American Journal of Physical Medicine & Rehabilitation: September 1998 - Volume 77 - Issue 5 - p 412-414
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Abstract

The need to expand the quantity and quality of physiatric research has been noted by multiple authorities.1-9 As noted by Grabois and Fuhrer,10 although physiatrists believe that research is important to the continuing development of the specialty, very few physiatrists devote much time to it. Part of this is the result of a lack of research training.11, 12

Some residency training programs have made research a mandatory part of the training, and graduating residents are encouraged to participate in a research fellowship program to strengthen their skills.13, 14 Funding agencies such as the National Institute on Disability and Rehabilitation Research and the National Institutes of Health through the National Center for Medical Rehabilitation Research have sponsored training grants to prepare rehabilitation trainees to pursue academic careers. The Association of Academic Physiatrists is the host for the National Institutes of Health K-12 program, in which faculty from one physical medicine and rehabilitation department can go to another department to develop specific research skills with the provision that, on completion of their training, they will return to their university and have guaranteed protected research time. Yet, there is no report in the literature as to how these graduates of physiatry research fellowship programs have perceived their training and what they think may need to be modified.

METHODOLOGY

A three-page, 22-question survey form with a comment section was developed. The survey (available upon request) was piloted by fellow research trainees and by Dr. Krotoski at the National Center for Medical Rehabilitation Research. It was modeled after the one by Fasser et al.,15 which evaluated geriatric fellows' research training. Physiatric research fellows were identified from lists that were supplied by the Association of Academic Physiatrists, National Institute on Disability and Rehabilitation Research, and National Center for Medical Rehabilitation Research. The specific research fellow training sites were also asked to provide us with a list of those physiatrists who had graduated from their research training fellowships and their current addresses, if known. This survey was mailed to the 42 physiatry research fellows identified in the fall of 1997. This along with one follow-up mailing yielded 29 (69%) usable surveys.

The 22 items were paired with the five-part Likert scale, with 1 indicating strong disagreement, 2 = disagreement, 3 = uncertain; 4 = agreement, and 5 = strong agreement. The data were analyzed to include the minimum and maximum scores as well as the means and standard deviations.

RESULTS

The results are presented in Table 1. First authorship on research papers and that the researcher should be the presenters of the findings were rated to be most critical. The issue of a competent research mentor was believed to be critical, followed by protected time, involvement in formal journal clubs, involvement with multiple mentors, and formal instruction in research skills. Trainees stressed in the comments section that the fellow should be closely supervised by a mentor at every level of research training. The concept of multiple mentors was frequently mentioned as being positive. It was also noted that it may be difficult to start and complete a prospective study in 1 yr, unless work has been accomplished before the start of the research fellowship. Many stressed that the research fellowship should be at least 80% research. A plea was made for physiatry departments to strongly encourage research from both their faculty and their residents. Protected research time for trainees and faculty was stressed both in the comment section and in the survey, and the idea that research can/should be done in one's "spare time" at night and on weekends was rejected. If residents and fellows are not encouraged/directed to include and appreciate research in their daily schedules, to ask questions, and to look for answers, then it is feared that graduating residents will have neither the time nor the inclination to perform research.

TABLE 1
TABLE 1:
Results of survey

DISCUSSION

Academically oriented fellowships in rehabilitation medicine have been available for approximately 14 yr,13 although those from the National Institutes of Health have only been in effect for 5 yr and the Association of Academic Physiatrists K-12 for 3 yr. However, few physiatric trainees have completed these programs. Because there are no curriculum standards for the research fellowship, this survey was developed to see how the trainees perceived their training needs. This survey was not sent to the mentors, and we currently do not have information as to whether their views agreed or disagreed with the trainees.

The results of this study indicate that those physiatric research fellows who completed the survey preferred a rigorous research preparation. They have concerns about finding competent physiatry researchers and having protected research time once they start their academic careers. The multiple mentor concept from within as well as outside the department was stressed to obtain the necessary skills to become a successfully funded researcher.

In 1984, Stolov12 challenged the field to produce 20 physiatrists each year who are trained in rehabilitation research. It is doubtful whether this goal has been reached, even today. He suggested that it should be no great problem to monitor these trainees, although his model was incorporated into the residency and not into fellowship years. His survey did not suggest how to monitor the trainee on completion as to whether they pursued an academic career or would become an independent grant-funded investigator. Also, he did not discuss measuring publications in peer-reviewed journals, but because this is one measure of academic research productivity, it needs to be monitored.9, 16 We also did not inquire about the individual's postresearch fellowship academic productivity. This needs to be done.

It is of interest to note that the research fellows surveyed in our study favored a 2-yr fellowship. This is in contrast to the 1991 overall physiatric resident survey of prospective fellowships, which indicated that they would be uninterested in fellowships exceeding 1 yr in duration.17 However, approximately 94% of those respondents who were interested in fellowships wanted a minimum of 50% of their time devoted to clinical experiences.

Studies of academic physicians show a clear relationship between duration of postclinical research training and research productivity and indicate that 2 yr of postclinical training is remarkably effective. A survey of 5,604 faculty members in departments of medicine, 4,200 of whom had postclinical research training, indicated that 43.8% of individuals with MD/PhD degrees and no additional training as fellows were active researchers.18 In contrast, only 15.2% of the physicians without research fellowship training actively pursued research as academic faculty. However, 48% of physicians who had received 2-yr postclinical research training were active researchers.18

CONCLUSION

This survey demonstrated the physiatric research fellows' perceptions of their training. We theorize that the structured training in research methodology, effective research mentor process, and the learning of the research milieu will result in higher research productivity by these physiatrists. It will be important to prospectively follow their research productivity to test this hypothesis.

REFERENCES

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2. Grabois M, Fuhrer MJ: Physiatrists' views on research. Am J Phys Med Rehabil 1988;67:171-174.
3. Braddom RL: Why is physiatric research important? Am J Phys Med Rehabil 1991;70:61-62.
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12. Stolov WC: Rehabilitation research training. Arch Phys Med Rehabil 1984;65:54-56.
13. DeLisa JA: Academic physiatry: trends, opportunities and challenges. Am J Phys Med Rehabil 1993;72:113-116.
14. Blake DJ, Lezotte DC, Yablon S, Rondinelli RD: Structured research training in residency training programs. Am J Phys Med Rehabil 1994;73:245-250.
15. Fasser CE, Smith QW, Luchi RJ: Geriatrics fellows' perceptions of the quality of their research training. Acad Med 1992;67:696-698.
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17. DeLisa JA, Jain SS, Yablon SA: Resident interest in physical medicine and rehabilitation fellowships: results of a survey. Am J Phys Med Rehabil 1991;70:290-293.
18. Levey GS, Sherman CR, Gentile NO, Hough LJ, Dial TH, Jolly P: Postdoctoral research training of full-time faculty in academic departments of medicine. Ann Intern Med 1988;109:414-418.
Keywords:

Research Training; Fellowships; Graduate Medical Education; Physical Medicine and Rehabilitation

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