Education Columns

By Donald Pine, MD, University of Minnesota Methodist Hospital FMR, St. Louis Park, MN; Richard Mitchell, MD, University of Minnesota, Minneapolis; Teresa Quinn, MD, Lynn Manning, MD, University of Minnesota Methodist Hospital FMR, St. Louis Park, MN; Anne Schullo-Feulner, PharmD, BCPS, University of Minnesota, Minneapolis; Deborah Mullen, PhD, University of Tennessee at Chattanooga  

Few family physicians carry out research during their careers, and interest in family medicine is inversely related to an interest in research.¹ However, engaging family physicians in research is critical to developing a family medicine workforce that can adapt to meet the needs of a changing population.² Here, we reflect on the effect of increased faculty engagement and support on the participation of our family medicine residents in research.

Building the Foundation, Acknowledging the Challenges
In 2010, recognizing the desire to increase research activity in our family medicine residency without making it a formal program requirement, our program director appointed a work group of three faculty members with a history of research activity. Prior to the creation of this work group, residents had had only two or three scholarly presentations in the preceding 5 years—our ACGME mandated scholarly activity is fulfilled in other ways. Other key elements for research were already in place: faculty support, a monthly resident journal club, on-call assistance from a PhD research methodologist, and funding to support resident presentations at external meetings.

Residents often lack time to define research projects, so the work group identified research ideas and areas of focus to serve as springboards.^3,4 Potential projects were those that were pertinent to clinical practice, viable within the clinical setting, and supported by faculty mentors. The work group presented their projects as outlines so residents could gauge the scope of the project and potential time commitment.

The amount of protected time residents could devote to research would depend on individual resident needs, goals, and rotation schedule. Because resident availability varied based on their clinical schedule, increased research efforts were encouraged during less demanding rotations. Residents were encouraged to work on projects in teams to spread the responsibility for completion among many, and they were encouraged to start early in the program to allow them time to complete projects during their training period.

Case Example: Pharmacy Consults at Discharge
This idea developed after two faculty physicians and a pharmacist noted the large number of patients on the residency inpatient service with complex medication issues. Two residents developed various data collection tools, encouraged peers to refer patients for study recruitment, and assessed evaluation surveys. They also collaborated with the pharmacists to overcome obstacles in implementing the consult service and developed a more efficient care process, which resulted in more focused consults. They completed the project despite delays caused by clinical rotation requirements and presented their results at a national meeting. The residents reported that this project was a valuable learning experience and that they would feel more comfortable participating in practice-based research in the future.

Results
Throughout the past 6 years, 11 of our 36 residency graduates participated in a total of five research projects (see table 1). Residents have presented each of these projects at regional or national research forums. Most of these projects required the efforts of multiple residents over several years to reach completion. In 2018, the work group added a resident member to help encourage residents to participate in research. The resident promotes peer scholarship, helps residents select projects, and helps faculty better appreciate the resident perspective.

Table 1: Resident Research Projects from 2012 to 2019  

Lessons Learned
A key to the success of the work group has been extensive faculty involvement in resident research projects—initially by formulating good clinical questions and then later by mentoring residents through the research process. When faculty identified and researched significant practice issues that were familiar to the residents and then developed a study proposal framework, the residents became more attracted to the projects and successfully implemented them. A limitation of this approach is that residents can miss out on the initial study development and background investigation.

Corresponding Author: Donald Pine, MD, University of Minnesota Methodist Hospital FMR, St. Louis Park, MN donald.pine@parknicollet.com 

References

1. Seehusen DA, Weaver SP. Resident Research in Family Medicine: Where are we now? Fam Med. 2009; 41(9):663-8. https://fammedarchives.blob.core.windows.net/imagesandpdfs/fmhub/fm2009/October/Dean663.pdf
2. Hester CM, Jiang V, Bartlett-Esquiliant et.al. Supporting Family Medicine Research Capacity: The Critical Role and Current Contributions of US Family Medicine Organizations. Fam Med. 2019; 51(2):120-8. https://doi.org/10.22454/FamMed.2019.318583
3. Rothberg MB. Overcoming Obstacles to Research during Residency. JAMA. 2012; 308:2191-2. https://doi.org/10.1001/jama.2013.1334
4. Ledford CJW, Seehusen DA, Villagran MM, Cafferty LA, Childress MA. Resident Scholarship Expectations and Experiences: Sources of Uncertainty as Barriers to Success. J Grad Med Educ. 2013; 5(4):564-9. https://doi.org/10.4300/JGME-D-12-00280.1