- Email: [email protected]
A Structured Step-by-Step Program to Increase Scholarly Activity
2014 APDS SPRING MEETING
A Structured Step-by-Step Program to Increase Scholarly Activity Kandace Kichler, MD,* Robert Kozol, MD,* Jessica Buicko, MD,* Beth Lesnikoski, MD,* Leonardo Tamariz, MD,*,† and Ana Palacio, MD*,† *
Department of Surgery, University of Miami Palm Beach Regional Campus, Atlantis, Florida; and Department of Medicine, University of Miami, Miami, Florida
†
OBJECTIVES: Development and maintenance of scholarly activity is a challenge for small community-based surgical training programs. The current Accreditation Council for Graduate Medical Education Program Requirements in General Surgery states that, “Residents should participate in scholarly activity,” and “The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.” We adopted a program designed to improve the quality of research projects pursued by surgical residents and to increase the number of projects submitted for both presentation and publication.
potential additional benefit is the ability to involve private surgical faculty with the residentsʼ projects. ( J Surg 71:e19C 2014 Association of Program Directors in Surgery. e21. J Published by Elsevier Inc. All rights reserved.)
DESIGN: We hereby describe a structured step-by-step
INTRODUCTION
program to mentor surgical residents through clinical projects from development to publication. SETTING: Community hospital with academic affiliation, located in the Southeastern United States. PARTICIPANTS: The Resident Scholarly Activity Program
at our facility includes 2 faculty mentors who work in direct contact with all the surgical residents of our program (2 residents/y, postgraduate years 1-5). The faculty members are MD, MPH professionals who specialize in resident education and scholarly activity. RESULTS: Implementation of Resident Scholarly Activity Program instruction and mentoring increased the number of publications in all categories defined. The number of publications and presentations increased from 6 to 28 over a 1-year period. CONCLUSIONS: A structured scholarly activity program
positively affects the number of clinical projects produced by a small community-based surgical training program. Familiarity with project design and biostatistics, plus one-on-one mentoring improves the quality of research produced. A Correspondence: Inquiries to Kandace Kichler, MD, Department of Surgery, University of Miami Palm Beach Regional Campus, 6301 S Congress Avenue, Atlantis, FL 33460; e-mail: [email protected]
KEY WORDS: resident education, publications, scholarly activity, resident research, surgical education, community program COMPETENCIES: Medical Knowledge, Professionalism,
Practice-Based Learning and Improvement
The University of Miami (UM) Palm Beach Regional Campus Surgical Residency is a University-affiliated, community-based program at a 460-bed hospital in Atlantis, Florida. There are 2 residents in each postgraduate year. The current Accreditation Council for Graduate Medical Education Program Requirements in General Surgery states that, “Residents should participate in scholarly activity,” and “The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.”1 Our program requires production of at least 1 research project per resident by completion of their 5-year training. Unfortunately, one of the known challenges faced by community-based programs is the lack of large academic institution–driven projects, funding, and allocated research years for scholarly activity. The challenges of publishing research for surgical residents are frequently observed regardless of program size. However, large surgical programs with an established academic and research infrastructure are at a greater advantage when it comes to producing high-quality research. Newer programs and small community-based surgical programs have several obstacles to overcome before reaching the expected level of production of a large-scale program. These include, but are not limited to, lack of research facilities, mentors, funding, and general interest.
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.08.008
e19
To overcome the previously mentioned obstacles, the Resident Scholarly Activity Program (RSAP) was developed at the UM and was brought to the regional campus in 2012. RSAP is dedicated to providing a quality research experience for the residents by facilitating qualified and available mentors along with RSAP staff to increase the possibility for success of the surgical residents. The RSAP is integrated into the weekly core curriculum schedule for our residents. Every resident in our program has access to and participates in RSAP activities on a regular basis. The RSAP activities are broken down and divided into 3 phases, which progressively promote scholarly activity and publication of quality surgical research.
METHODS Phase 1 begins in the residentsʼ 5-year program with a series of online modules plus live lectures. This reinforces epidemiology and statistics, facilitates identification of mentors, and prepares the resident for institutional review board submission. During this time, the RSAP faculty also explores the resident’s areas of interests and future career goals. At the end of this phase, the resident should have a basic grasp of epidemiology and statistics. In phase 2, residents meet with instructors one-on-one, become more facile with statistics, and discuss the feasibility of their projects. Research milestones are established and met to assure the likelihood of success for the project. Residents give progress reports to the faculty, evaluating their own progress as well as the quality of their project, and the availability and expertise of their mentor. The third phase includes completion of the project. This entails final data collection, statistical analysis of the results, a formal presentation of the methods and findings, and preparation for publication of the findings. The interactions between residents and RSAP faculty are designed to model a residentʼs daily “work” rather than “lecture.” The instruction is practical, and involves group discussion to maintain interest and focus. In addition, the residents work as a team. By doing so, each resident hears what their colleagues are doing, they learn from each other, and no one is left to work on large-scale projects without guidance. We find this aspect of the program unique to the RSAP and feel that it promotes a friendly, positive experience in the development of scholarly activity amongst the residents, mentors, and faculty. The outcomes for the purpose of this study include the number of presentations at local meetings, presentations at regional/national meetings, papers submitted, and articles published. We include both oral and poster presentations. Papers submitted include case reports as well as traditional manuscripts. To collect the data, we requested a list of all of the aforementioned measures on an individual basis, and each resident self-reported their scholarly activity. e20
RESULTS In the first year of our program (2011-2012, 6 residents, 2 per year postgraduate year 1 [PGY1]-PGY3), 6 scholarly activity items (SAI) met the criteria to be included in our study. That year, 3 presentations were given at local meetings, 1 presentation was given at a national meeting, and 1 paper was submitted for publication. One article was published. The mean number of SAI per resident in this academic year was 1. From 2012 to 2013, the second year of our program and the inaugural year of the RSAP, scholarly activity increased. This year the program consisted of 8 total residents (2 per year, PGY1-PGY4), and of those 8, 28 different SAI were produced. The mean number of SAI per resident was 3.5 (Table).
DISCUSSION A recent study at a major orthopedic academic teaching center concluded that a more organized and structured program for scholarly activity significantly increased the number of grants and peer-reviewed publications.2 Our findings reveal that even small community-based surgical residency programs can achieve growth and success in terms of scholarly activity. We believe that similar surgical programs can feasibly meet Accreditation Council for Graduate Medical Education requirements by putting into place a system that promotes mentoring and provides oneon-one time between faculty and residents, and residents and mentors. For decades, a common citation (especially for small programs) has been a lack of scholarly activity. As reported by Manring et al.,3 the major obstacles to residents participating in research include, lack of time, lack of infrastructure, lack of mentoring, and lack of financial support. Having mentors with previous publications is hypothesized to increase the success of such a program, as studied in a larger program before initiation at our facility.4,5 Our RSAP program addresses all of these concerns. This program functions well, produces results, and is very manageable. One may ask why this is different than just telling residents “go out and do this.” The answer lies in the TABLE. Resident Scholarly Activity Items (SAI) Produced by Our Surgical Residents. Academic Year 2011 to 2012 Was Prior to Development of the Resident Scholarly Activity Program Resident Projects Presentations at local meetings Presentations at regional/ national meetings Papers submitted Articles published
2011 to 2012
2012 to 2013
3 1
7 5
1 1
11 5
Journal of Surgical Education Volume 71/Number 6 November/December 2014
fact that most residents are not trained to do these things. The structured training including one-on-one mentoring through each phase gives the residents the tools to accomplish the task.6 We believe that this model could be duplicated in many residency programs. Methods for implementing such a program include purchasing the program directly from the UM (or purchasing a similar program). Alternatively, a residency may hire 1 or more experienced clinical research staff but this comes with considerable expense. The strengths of our study include the structured design including well-scheduled group and one-on-one instruction. We directly collected data from each resident. The RSAP is ongoing, and further data will be available as the program continues. At the time of this manuscript submission (March 2014), 66 SAI have been performed by our program to date, indicating continued success and progression of scholarly activity amongst our residents. Limitations of our study include the limited time frame the RSAP has been in place. We collected data from the first year of our program—during which only PGY1 to PGY3 resident positions were filled (2 residents/PGY level, 6 total residents). The second year of data including initiation of RSAP is augmented by an additional 2 residents (at this stage, PGY levels 1-4 positions were filled). Thus, the increased volume of scholarly activity could be a reflection of the increased size of the residency program. A survey of all the residents at our program resulted in a unanimous opinion that the increase in scholarly activity at our program is a direct result of the RSAP and not a result of extra time owing to an increased work force. The study also lacks a control group. The time residents spend with the RSAP is typically during dedicated core curriculum hours, therefore an increased number of residents did not add to dedicated time for RSAP. It is also difficult to determine if there has been a Hawthorne effect. The establishment of the residency program has definitely changed the research and academic environment at our institution, thereby producing more scholarly activity from surgeons who otherwise would do very little if any research outside of their private practice duties. This factor of residents asking questions, inquiring for research, and improving the scholarly activity level in our institution is considered a positive side benefit of the
RSAP. So, can the momentum of our RSAP be sustained? We sense that the RSAP has changed the culture in our facility in a positive way. We believe that the skills learned through the RSAP can be maintained and can carry the resident through scholarly activity throughout their residency training.
CONCLUSION A structured scholarly activity program positively affects the number of clinical projects produced by a small community-based surgical training program. Familiarity with project design and biostatistics, plus one-on-one mentoring improves the quality of research produced. A potential side benefit is the ability to involve private surgical faculty with the residentsʼ projects.
REFERENCES 1. Accreditation Council for Graduate Medical Education.
Residency Program Training Requirements. Chicago: Accreditation Council for Graduate Medical Education; 2012. 2. Robbins L, et al. Restructuring the orthopedic resident
research curriculum to increase scholarly activity. J Grad Med Educ. 2013;5(4):646-651. 3. Manring MM, Panzo JA, Mayerson JL. A framework for
improving resident research participation and scholarly output. J Surg Educ. 2014;71(1):8-13. 4. Palacio A, Campbell DT, Moore M, Symes S, Tamariz
L. Predictors of scholarly success among internal medicine residents. Am J Med. 2013;126(2):181-185. 5. Healy NA, Cantillon P, Malone C, Kerin MJ. Role
models and mentors in surgery. Am J Surg. 2012;204 (2):256-261. 6. Philibert I, et al. Scholarly activity in the next accred-
itation system: moving from structure and process to outcomes. J Grad Med Educ. 2013;5(4):714-717.
Journal of Surgical Education Volume 71/Number 6 November/December 2014
e21
A Structured Step-by-Step Program to Increase Scholarly Activity Kandace Kichler, MD,* Robert Kozol, MD,* Jessica Buicko, MD,* Beth Lesnikoski, MD,* Leonardo Tamariz, MD,*,† and Ana Palacio, MD*,† *
Department of Surgery, University of Miami Palm Beach Regional Campus, Atlantis, Florida; and Department of Medicine, University of Miami, Miami, Florida
†
OBJECTIVES: Development and maintenance of scholarly activity is a challenge for small community-based surgical training programs. The current Accreditation Council for Graduate Medical Education Program Requirements in General Surgery states that, “Residents should participate in scholarly activity,” and “The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.” We adopted a program designed to improve the quality of research projects pursued by surgical residents and to increase the number of projects submitted for both presentation and publication.
potential additional benefit is the ability to involve private surgical faculty with the residentsʼ projects. ( J Surg 71:e19C 2014 Association of Program Directors in Surgery. e21. J Published by Elsevier Inc. All rights reserved.)
DESIGN: We hereby describe a structured step-by-step
INTRODUCTION
program to mentor surgical residents through clinical projects from development to publication. SETTING: Community hospital with academic affiliation, located in the Southeastern United States. PARTICIPANTS: The Resident Scholarly Activity Program
at our facility includes 2 faculty mentors who work in direct contact with all the surgical residents of our program (2 residents/y, postgraduate years 1-5). The faculty members are MD, MPH professionals who specialize in resident education and scholarly activity. RESULTS: Implementation of Resident Scholarly Activity Program instruction and mentoring increased the number of publications in all categories defined. The number of publications and presentations increased from 6 to 28 over a 1-year period. CONCLUSIONS: A structured scholarly activity program
positively affects the number of clinical projects produced by a small community-based surgical training program. Familiarity with project design and biostatistics, plus one-on-one mentoring improves the quality of research produced. A Correspondence: Inquiries to Kandace Kichler, MD, Department of Surgery, University of Miami Palm Beach Regional Campus, 6301 S Congress Avenue, Atlantis, FL 33460; e-mail: [email protected]
KEY WORDS: resident education, publications, scholarly activity, resident research, surgical education, community program COMPETENCIES: Medical Knowledge, Professionalism,
Practice-Based Learning and Improvement
The University of Miami (UM) Palm Beach Regional Campus Surgical Residency is a University-affiliated, community-based program at a 460-bed hospital in Atlantis, Florida. There are 2 residents in each postgraduate year. The current Accreditation Council for Graduate Medical Education Program Requirements in General Surgery states that, “Residents should participate in scholarly activity,” and “The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.”1 Our program requires production of at least 1 research project per resident by completion of their 5-year training. Unfortunately, one of the known challenges faced by community-based programs is the lack of large academic institution–driven projects, funding, and allocated research years for scholarly activity. The challenges of publishing research for surgical residents are frequently observed regardless of program size. However, large surgical programs with an established academic and research infrastructure are at a greater advantage when it comes to producing high-quality research. Newer programs and small community-based surgical programs have several obstacles to overcome before reaching the expected level of production of a large-scale program. These include, but are not limited to, lack of research facilities, mentors, funding, and general interest.
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.08.008
e19
To overcome the previously mentioned obstacles, the Resident Scholarly Activity Program (RSAP) was developed at the UM and was brought to the regional campus in 2012. RSAP is dedicated to providing a quality research experience for the residents by facilitating qualified and available mentors along with RSAP staff to increase the possibility for success of the surgical residents. The RSAP is integrated into the weekly core curriculum schedule for our residents. Every resident in our program has access to and participates in RSAP activities on a regular basis. The RSAP activities are broken down and divided into 3 phases, which progressively promote scholarly activity and publication of quality surgical research.
METHODS Phase 1 begins in the residentsʼ 5-year program with a series of online modules plus live lectures. This reinforces epidemiology and statistics, facilitates identification of mentors, and prepares the resident for institutional review board submission. During this time, the RSAP faculty also explores the resident’s areas of interests and future career goals. At the end of this phase, the resident should have a basic grasp of epidemiology and statistics. In phase 2, residents meet with instructors one-on-one, become more facile with statistics, and discuss the feasibility of their projects. Research milestones are established and met to assure the likelihood of success for the project. Residents give progress reports to the faculty, evaluating their own progress as well as the quality of their project, and the availability and expertise of their mentor. The third phase includes completion of the project. This entails final data collection, statistical analysis of the results, a formal presentation of the methods and findings, and preparation for publication of the findings. The interactions between residents and RSAP faculty are designed to model a residentʼs daily “work” rather than “lecture.” The instruction is practical, and involves group discussion to maintain interest and focus. In addition, the residents work as a team. By doing so, each resident hears what their colleagues are doing, they learn from each other, and no one is left to work on large-scale projects without guidance. We find this aspect of the program unique to the RSAP and feel that it promotes a friendly, positive experience in the development of scholarly activity amongst the residents, mentors, and faculty. The outcomes for the purpose of this study include the number of presentations at local meetings, presentations at regional/national meetings, papers submitted, and articles published. We include both oral and poster presentations. Papers submitted include case reports as well as traditional manuscripts. To collect the data, we requested a list of all of the aforementioned measures on an individual basis, and each resident self-reported their scholarly activity. e20
RESULTS In the first year of our program (2011-2012, 6 residents, 2 per year postgraduate year 1 [PGY1]-PGY3), 6 scholarly activity items (SAI) met the criteria to be included in our study. That year, 3 presentations were given at local meetings, 1 presentation was given at a national meeting, and 1 paper was submitted for publication. One article was published. The mean number of SAI per resident in this academic year was 1. From 2012 to 2013, the second year of our program and the inaugural year of the RSAP, scholarly activity increased. This year the program consisted of 8 total residents (2 per year, PGY1-PGY4), and of those 8, 28 different SAI were produced. The mean number of SAI per resident was 3.5 (Table).
DISCUSSION A recent study at a major orthopedic academic teaching center concluded that a more organized and structured program for scholarly activity significantly increased the number of grants and peer-reviewed publications.2 Our findings reveal that even small community-based surgical residency programs can achieve growth and success in terms of scholarly activity. We believe that similar surgical programs can feasibly meet Accreditation Council for Graduate Medical Education requirements by putting into place a system that promotes mentoring and provides oneon-one time between faculty and residents, and residents and mentors. For decades, a common citation (especially for small programs) has been a lack of scholarly activity. As reported by Manring et al.,3 the major obstacles to residents participating in research include, lack of time, lack of infrastructure, lack of mentoring, and lack of financial support. Having mentors with previous publications is hypothesized to increase the success of such a program, as studied in a larger program before initiation at our facility.4,5 Our RSAP program addresses all of these concerns. This program functions well, produces results, and is very manageable. One may ask why this is different than just telling residents “go out and do this.” The answer lies in the TABLE. Resident Scholarly Activity Items (SAI) Produced by Our Surgical Residents. Academic Year 2011 to 2012 Was Prior to Development of the Resident Scholarly Activity Program Resident Projects Presentations at local meetings Presentations at regional/ national meetings Papers submitted Articles published
2011 to 2012
2012 to 2013
3 1
7 5
1 1
11 5
Journal of Surgical Education Volume 71/Number 6 November/December 2014
fact that most residents are not trained to do these things. The structured training including one-on-one mentoring through each phase gives the residents the tools to accomplish the task.6 We believe that this model could be duplicated in many residency programs. Methods for implementing such a program include purchasing the program directly from the UM (or purchasing a similar program). Alternatively, a residency may hire 1 or more experienced clinical research staff but this comes with considerable expense. The strengths of our study include the structured design including well-scheduled group and one-on-one instruction. We directly collected data from each resident. The RSAP is ongoing, and further data will be available as the program continues. At the time of this manuscript submission (March 2014), 66 SAI have been performed by our program to date, indicating continued success and progression of scholarly activity amongst our residents. Limitations of our study include the limited time frame the RSAP has been in place. We collected data from the first year of our program—during which only PGY1 to PGY3 resident positions were filled (2 residents/PGY level, 6 total residents). The second year of data including initiation of RSAP is augmented by an additional 2 residents (at this stage, PGY levels 1-4 positions were filled). Thus, the increased volume of scholarly activity could be a reflection of the increased size of the residency program. A survey of all the residents at our program resulted in a unanimous opinion that the increase in scholarly activity at our program is a direct result of the RSAP and not a result of extra time owing to an increased work force. The study also lacks a control group. The time residents spend with the RSAP is typically during dedicated core curriculum hours, therefore an increased number of residents did not add to dedicated time for RSAP. It is also difficult to determine if there has been a Hawthorne effect. The establishment of the residency program has definitely changed the research and academic environment at our institution, thereby producing more scholarly activity from surgeons who otherwise would do very little if any research outside of their private practice duties. This factor of residents asking questions, inquiring for research, and improving the scholarly activity level in our institution is considered a positive side benefit of the
RSAP. So, can the momentum of our RSAP be sustained? We sense that the RSAP has changed the culture in our facility in a positive way. We believe that the skills learned through the RSAP can be maintained and can carry the resident through scholarly activity throughout their residency training.
CONCLUSION A structured scholarly activity program positively affects the number of clinical projects produced by a small community-based surgical training program. Familiarity with project design and biostatistics, plus one-on-one mentoring improves the quality of research produced. A potential side benefit is the ability to involve private surgical faculty with the residentsʼ projects.
REFERENCES 1. Accreditation Council for Graduate Medical Education.
Residency Program Training Requirements. Chicago: Accreditation Council for Graduate Medical Education; 2012. 2. Robbins L, et al. Restructuring the orthopedic resident
research curriculum to increase scholarly activity. J Grad Med Educ. 2013;5(4):646-651. 3. Manring MM, Panzo JA, Mayerson JL. A framework for
improving resident research participation and scholarly output. J Surg Educ. 2014;71(1):8-13. 4. Palacio A, Campbell DT, Moore M, Symes S, Tamariz
L. Predictors of scholarly success among internal medicine residents. Am J Med. 2013;126(2):181-185. 5. Healy NA, Cantillon P, Malone C, Kerin MJ. Role
models and mentors in surgery. Am J Surg. 2012;204 (2):256-261. 6. Philibert I, et al. Scholarly activity in the next accred-
itation system: moving from structure and process to outcomes. J Grad Med Educ. 2013;5(4):714-717.
Journal of Surgical Education Volume 71/Number 6 November/December 2014
e21