Introduction to Research in Residency

Congratulations! You made it — not only to residency — but through residency orientation. If you committed to memory all the information presented during orientation, then you should have all the skills you need to keep yourself out of trouble as you begin the journey to patient care and practice management.

Presumably, you also received information on residency scholarly requirements and resources to help you meet those requirements. What? You don’t remember hearing about scholarly activity or research? Well, maybe that came up once or twice, but it didn’t seem nearly as important as how to find the cafeteria or contact the attending on call.

All residents have at least one scholarly requirement and it is in your best interest to find out exactly what that requirement is before you are up to your elbows in ICU cases.

You may say, “I have plenty of time,” and you certainly do right now. But, that time will fly by and “plenty” will turn into “not enough” in the blink of an eye. Please keep in mind that scholarly activity, specifically some types of research, cannot be effectively completed in a matter of weeks — it takes months to years if the experience is to be of any value.

You may also say, “But, I don’t know anything about research and I don’t plan to do any research after residency.” Maybe…or maybe not — a lot will change during residency, including clinical interests, life situations, and professional course. Whether you pursue a career as a physician-scientist, academic clinician, or a private practitioner hosting an occasional resident or medical student, scholarly activity will resurface and you will need some basic skills to navigate that world. In this post, I hope to provide enough information to get you started on your scholarly activity journey.

There are two types of scholarly requirements for residency programs: Accreditation Council for Graduate Medical Education (ACGME) requirements and institutional program requirements. Both common program requirements and specialty requirements are explained on the ACGME website. The research curriculum in your program already takes into account scholarly activity requirements for residents and teaching faculty; however, some programs have additional requirements to strengthen training in research methodology. The most efficient way to understand how much and what type of scholarly activity is required is to discuss them with your Residency Program Director or Residency Research Director.

Developing a Plan

Once you know your requirements, it’s time to develop a plan, taking into consideration your career goals. If you wish to pursue a fellowship after residency, you will want to complete the bulk of your scholarly activity in time to include on your applications. Otherwise, you are expected to complete scholarly activity by the end of residency or fellowship training.

If one requirement is to present your scholarly activity before the end of residency, you will need to meet abstract deadlines (and possibly print deadlines). These dates can be weeks to months before the actual presentation date. And keep in mind that your manuscript or abstract may not be accepted for publication the first, or even second, time it is submitted. Therefore, it is important to develop a reasonable plan to complete the necessary tasks and stick to it. Throughout residency, you will have many competing interests (educational, family, and life in general). Without a plan, the end result will be added stress, academic consequences, and the inability to learn from the activities (the ultimate goal).

Getting Started

Once you have a plan, where do you begin? Despite the tendency to focus on a particular discipline if you plan to pursue a fellowship, the value of engaging in scholarly activity is to learn a skill set that can be applied to any discipline or research question. Nonetheless, it will be easier to begin, and stay invested if you have a genuine interest in the topic.

Start with low-hanging fruit. For example, if you encounter a fascinating clinical case that you think adds value to the medical community, consider preparing a clinical vignette or case report for presentation or publication (see ACP’s Writing a Clinical Vignette or Case Report Abstract). You will learn how to present a case within a clinical context and in relation to existing knowledge, and in the process, develop literature search skills (including obtaining journal articles and resources electronically, learning what is available through your institution and network libraries, and meeting the medical librarian). These skills will facilitate the process of designing a research study and preparing the proposal in the future.

You can also think about cases or rotations you encountered during medical school or topics that sparked your interest in medicine. Once you identify a general area of interest, you will need to narrow the scope to avoid the frustration of tackling a research question that is too vague or large.

Experiencing success from the start will foster your enthusiasm to engage in the project; experiencing frustration will just make the process seem like a lot of work!

If you have difficulty identifying a topic or narrowing an area of interest, talk to peers, clinical faculty, or research support faculty or staff. This might include talking to a faculty mentor about a topic of interest or asking if they have a project that you can help with.

The ideal topic may take you down a nontraditional path (e.g., quality improvement or public health). The medical librarian at your institution can help you use navigation tools for an exploratory search in literature databases including MEDLINE via PubMed. You might begin with one keyword or phrase and 30 minutes later end up reading articles on a topic you previously thought was unrelated. Once you have identified a topic or research question and refined it, you can begin to prepare a research proposal.

The Research Proposal

The term “research proposal” is frequently used as if everyone should know exactly what it means. The research proposal is a detailed plan that describes your research question and explains why it is meaningful, what you expect the answer to be, how you plan to answer the question, and what you plan to do once you have found the answer. In general, the sections of a research proposal include:

1. Introduction/background

2. Objectives

3. Methods

4. Data collection

5. Data analysis

6. Ethical considerations

7. Limitations

8. Significance

9. Plans for dissemination of findings

10. References

The proposal is the precursor to the end result, namely your presentation or manuscript. The more effort and detail you put into preparing the proposal, the less you will be required to do when you complete your research and prepare your final product. If you approach the proposal in this manner while you have the time and motivation, your overall experience will be much more pleasant.

Proposal Template

As you begin to gather information for your research proposal, look for a template on your institution’s intranet (under research resources or the Institutional Review Board. Templates are also available on the internet (view an annotated sample research protocol template here). Templates help you describe your research project, while insuring that you include the key components required for review. The research proposal will also help you identify key considerations and discussions (statistical support, ethics review, etc.) that need to take place before starting the project.

The Value of a Team

One resource that remains an integral part of scholarly activity during residency is collaboration with other members of your institution. These may be peers (from the same or different program), clinical or academic faculty (from the same or different discipline), ancillary clinical staff, and other support staff at your institution or other institutions. The team you put together will bring breadth and depth to your project, hold you accountable, and keep you on track toward completion. The early stage of your project is the best time to start assembling the team. The team can assist with protocol development and need for resources, identify potential confounding factors and logistical issues, and propose solutions.

The Review Process

Review of your proposal can include departmental peer review, ethics committee review (IRB for human subjects or Institutional Animal Care and Use Committee [IACUC] for animal subjects), and funding committee review.

Deadlines: As you prepare your research protocol, you will need to know what deadlines you are up against. For example, if you wish to apply for funding, you will need to know if ethics committee review is required. If this is the case, you will not only be working against the funding application deadline but also the deadline for getting on the ethics committee meeting agenda (often weeks before the meeting). And sometimes departmental or central peer review is required before ethics committee review. In such instances, you will need to build in lead time to draft your protocol for peer review.

Peer Review: The goal of peer review is to have your project reviewed by someone who is objective but who also has a strong background in the subject and research methods. Although peer review may seem like one more hoop to jump through, it will save you time and frustration in the long run. The peer reviewer can identify issues in study design, logistics and feasibility, sample size, and ethics. Imagine the frustration of completing data collection and realizing during data analysis that you do not have enough subjects to detect a significant difference between groups. Similarly, what if the ethics review is delayed because you failed to submit all of the required documents? Peer review will help you avoid such issues. The more seriously you take the feedback, the smoother and more efficient the pathway will be to approval, and possibly, funding.

Ethics Committee Review: If your project involves human subjects (even if only Protected Health Information [PHI]) or animal subjects, it must be reviewed by your institutional ethics committee for the appropriate and just use of subjects under principles outlined and regulated by federal agencies. The best way to learn about the information required in your protocol is to contact the institutional coordinator of the respective ethics committee. You can start these discussions while you are preparing your protocol and complete many of the steps (such as training and credentialing) during protocol development. The coordinator is an important resource because, although requirements are fixed, he or she can guide you through the most thorough and efficient way to meet the requirements.

Funding

Opportunities for funding your research project may include institutional seed money, local foundations, National/Regional Associations or Foundations, as well as federal agencies (NIH, AHRQ, etc.). When considering funding options, be sure to “right-size” your pursuits. Many discipline-specific organizations have funding in modest amounts earmarked for resident and fellow research projects. Be sure to designate enough time to thoroughly examine the guidelines and requirements. If possible, review previous projects that were funded by the organization to help you determine if the scope of your project is a good fit. You can also contact the grant program administrator for additional information.

Green Means Go: Things to Consider for Data Collection

Once you have assembled your team and have received the necessary approvals (and possibly funding), you are ready to begin your project. The following measures are essential to consider before data collection begins:

• Establish the division of labor and the order of authorship across the team to avoid conflict or bad feelings when the time comes to present or publish your work.

• Standardize the collection tools so everyone collects the same information. Data collection tools include spreadsheets and electronic databases (e.g., Microsoft databases or REDCap).

• Preserve the integrity of the data if more than one person has access to the data.

• Secure the data (including the 18 identifiers protected by HIPAA) on an encrypted drive or server.

• Back up all data frequently and in multiple locations.

Nothing is more frustrating than finding out that the data you spent hours entering was lost when your hard drive crashes or the USB drive is lost. Even more dangerous is losing a USB drive with protected health information. Not taking these extra precautions puts both you and your research subjects at risk. Any privacy breaches should be reported to the Compliance Department immediately.

Concluding Remarks

You should now have enough information to get you started on your scholarly activity journey. Remember to make the best use of available resources, research support staff, and the members of your team. This phase of your career is about learning how to be a caregiver through “hands on” experience; this includes “learning” how to conduct research properly. To finalize a research project, you will need to understand the elements of data analysis and preparing a manuscript or presentation. But first, you have to GET STARTED!

For more on this topic, you might be interested in Once You’ve Found the Question: How to Take the Next Steps in Research.

Nairmeen Haller, PhD is the Director of Research at Cleveland Clinic Akron General in Akron Ohio.