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Rational resident research requirements: Reevaluating goals for research in otolaryngology-head and neck surgery residency programs

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July 18, 2016
by Quintin M. Cappelle, MD; Tara E. Brennan, MD; Miriam I. Redleaf, MD

The Accreditation Council for Graduate Medical Education (ACGME) in Otolaryngology requirements mandate that otolaryngology residencies provide 3 months of dedicated research time.1 The three reasons for requiring original research during residency are:

First, the residents must learn how to evaluate published information. The ACGME has identified six core competencies for otolaryngology resident physician training, two of which (practice-based learning and systems-based learning) require that residents use up-to-date medical research to provide the best patient care. Therefore, residents must learn how to interpret published research. The second reason to require resident research is to expose residents to the hurdles and procedures leading up to the peer-review process, should they want to pursue an academic career. The third reason is that the resident may indeed find a solution to an otolaryngologic problem that may benefit our patients.

ACGME requirements (ACGME section IV.B.2.a) also mandate “instruction in research methods and design, as well as outcome assessment…(and) should result in a completed manuscript suitable for publication in a peer-reviewed journal.”1 Unfortunately, in most studies of resident research efforts and requirements, the sole gauge of research activities becomes the published article. How did instituting protected time affect resident research efforts? It resulted in the increased peer-reviewed publications encouraged by the ACGME.2,3 How did increasing research education initiatives during residency affect resident research? It resulted in more publications from graduated residents.4

A point-based reward system to incentivize resident research resulted in an increased number of published case reports and retrospective clinical studies.5 Despite the benefits of the process of research, much focus has shifted to the end result-publication-to determine the success of resident research. Studies show that the individuals who publish the most during residency will continue to publish the most after residency.6,7 The number of publications becomes the currency of research success and the predictor of post-residency academic success.

It seems that to have a successful research experience, indeed to even graduate, the resident must acquire and present data that are suitable for publication. This can be problematic since findings of any research venture can flounder on any number of unforeseen obstacles. For example, the findings could be statistically significant but not clinically significant. Technical difficulties, such as resolution of scans or anatomic/physiologic variations of subjects, can impede gathering enough data to submit for publication.

Interventions requiring subjects to practice/study at home also can prove barriers to acquiring enough subjects and controls for a reliable answer. After a resident has conceived of a research question, reviewed the literature, designed the protocol, obtained institutional review board approval, arranged collaborations between specialties, collected the data, and analyzed them, there could still be no original or clinically useful finding to write up and submit for publication. This leaves the typical otolaryngology resident with a daunting requirement and no reliable mechanism for attaining it.

In the three otolaryngology residency programs with which the senior author (M.I.R.) has been associated, the research requirement remains the single most stressful aspect of residency training. For decades, in all three of those programs, yearly in-house research presentations are expected to show either clinically or statistically significant results.

Fortunately, there is now a newer field of residency education, which focuses on uncovering rational strategies to achieve educational goals. For example, considerable efforts are now being put into analyzing and improving teaching styles in the operating room8; into videotaping9 and analyzing management of emergencies10; and into creating longitudinal databases to track what happens to residents after graduation.10 In fact, the term faculty development itself has morphed from faculty sabbaticals and professional enrichment to increasing faculty members' ability to teach residents.11 The same rational approach can be used with resident research requirements.

We suggest that the focus of resident research return to the research process itself, with only one of the goals being to express the findings in the format of a submission to a scholarly journal. Along the way, residents should explore all the steps, from noticing a problem to presenting an answer. These steps include forming a hypothesis, deciding what data to gather, obtaining institutional review board approval, collaborating with other specialties, reorganizing the research technique when finding roadblocks, statistical analysis, and writing up the findings in the form of a submission for publication.

These findings can be presented at in-house conferences, or perhaps in regional or national poster or oral presentations with lower standards for acceptance than a peer-reviewed publication. Residents would be evaluated along each step of the way, much as they are currently evaluated for their specialty knowledge and their operative skills. If it happens that the results are of suitable originality and usefulness to submit for publication in a peer-reviewed journal, so much the better.

This proposed redirection of resident research efforts does not change basic realities of academic medicine. What is accepted for publication will still tend to be more original or useful than what is rejected. The published paper will still remain one standard of academic success. And while the ACGME does not require publication in a peer-reviewed journal for graduation, this will still remain a goal of the most ambitious of residents, and appropriately so.


Acknowledgment

The senior author would like to acknowledge the many and invaluable suggestions for improving this communication from Maureen Hannley, June 2, 2015.



References

  1. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Otolaryngology. Updated July 2016. www.acgme.org/Portals/0/280_otolaryngology_PRs_RC.pdf. Accessed May 27, 2016.
  2. Robbins L, Bostrom M, Marx R ,et al. Restructuring the orthopedic resident research curriculum to increase scholarly activity. J Grad Med Educ 2013; 5 (4): 646-51.
  3. Vinci RJ, Bauchner H, Finkelstein J ,et al. Research during pediatric residency training: Outcome of a senior resident block rotation. Pediatrics 2009; 124 (4); 1126-34.
  4. Sakai T, Emerick TD, Metro DG ,et al. Facilitation of resident scholarly activity: Strategy and outcome analyses using historical resident cohorts and a rank-to-match population. Anesthesiology 2014; 120 (1): 111-19.
  5. Chang CW, Mills JC. Effects of a reward system on resident research productivity. JAMA Otolaryngol Head Neck Surg 2013; 139 (12): 1285-90.
  6. Macknin JB, Brown A, Marcus RE. Does research participation make a difference in residency training? Clin Orthop Relat Res 2014; 472 (1): 370-6.
  7. Hsieh H, Paquette F, Fraser SA ,et al. Formal research training during surgical residency: Scaffolding for academic success. Am J Surg 2014; 207 (1): 141-5.
  8. Roberts NK, Williams RG, Kim WJ, Dunnington GL. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. J Am Coll Surg 2009; 208 (2): 299-303.
  9. McDowell CM, Roberts NK, Sutyak J ,et al. Be SMARTT about trauma: An interdisciplinary educational approach to improving teamwork in the trauma bay. Ann Emerg Med 2012; 60 (5): S172-3.
  10. Cook DA, Andriole DA, Durning SJ ,et al. Longitudinal research databases in medical education: Facilitating the study of educational outcomes over time and across institutions. Acad Med 2010; 85 (8): 1340-6.
  11. Roberts NK, Coplit LD. Future focus for professional development. Teach Learn Med 2013; 25 (Suppl 1): S57-61.
Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine
American Academy of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, New York Head and Neck Institute, NorthShore LIJ-Lenox Hill Hospital
Louis J. Mayer Professor, Director of Otology, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine
Ear Nose Throat J. 2016 July;95(7):252-254