On a survey publisher recently by Dattatray B. Pawar, et al, "‘Lack of time’ was cited as an obstacle for research by 74% of the residents, of which 66% felt that training in their specialty consumed most of their time and 42% of the residents admitted ‘lack of research curriculum’ as an obstacle".

On this same article "the residents were asked to state factors that could promote research. Most of them (66%) admitted that guidance from senior faculty was essential. Forty-six percent thought that reduction of working hours of residency could lead to more research involvement and 40% felt that financial assistance would help to promote research. Forty-four percent considered that a system of extra credit points for research-related presentations and publications would be helpful".

In my opinion, recruiting residents with strong research background + providing protected research time + creating a credit system to recognize physicians who demonstrate their commitment towards research activities is essential to fulfill your goal.

"Awareness about medical research among resident doctors in a tertiary care hospital: A cross-sectional Survey". Dattatray B Pawar et al. Perspect Clin Res. 2012 Apr-Jun 3(2):57-61 doi:10.4103/2229-3485.96446

On a survey publisher recently by Dattatray B. Pawar, et al, "‘Lack of time’ was cited as an obstacle for research by 74% of the residents, of which 66% felt that training in their specialty consumed most of their time and 42% of the residents admitted ‘lack of research curriculum’ as an obstacle".

On this same article "the residents were asked to state factors that could promote research. Most of them (66%) admitted that guidance from senior faculty was essential. Forty-six percent thought that reduction of working hours of residency could lead to more research involvement and 40% felt that financial assistance would help to promote research. Forty-four percent considered that a system of extra credit points for research-related presentations and publications would be helpful".

In my opinion, recruiting residents with strong research background + providing protected research time + creating a credit system to recognize physicians who demonstrate their commitment towards research activities is essential to fulfill your goal.

"Awareness about medical research among resident doctors in a tertiary care hospital: A cross-sectional Survey". Dattatray B Pawar et al. Perspect Clin Res. 2012 Apr-Jun 3(2):57-61 doi:10.4103/2229-3485.96446

One of the reasons is low perceived importance of research in clinical practice.

We used to organize 'clinical conference' where they were to present one case that they have attended in 'To To' . Discussions followed and students were awarded grades as per performance.

My experience has been that residents, post docs, interns and the like generally embrace every opportunity to advance their knowledge particularly in areas that they are engaged academically. As Ruth recommended, promote your research by conducting in-services, poster presentations and lectures about the work that you are doing and advertise on your institution's web site, newsletter, posting boards, library, etc. Focus your promotional efforts in departments and other specialty areas where your work is most applicable. If you can tie the work you're doing to a current trend or issue that has been spotlighted or newsworthy recently in your area of specialization, this will make it all the more appealing. I have had very good success with this approach. I hope that this will give you some ideas and prove helpful.

Research is many times not perceived as rewarding especially by residents.. and in face the scope for research is more when one is actually busy.. But whenever they are compelled to do it, at least a small portion of the group will develop interest and take up research religiously. In my opinion research has to be made as a part of curriculum in residency program. I believe proper documentation and channelization of data should be the beginning for any research, and when it is made and it is published, the candidate will keep a next step into a prospective study.. In general, until it is not made compulsory, its not going to be looked seriously.. but when someone is into this field he wont look back.. have a good day..

Very interesting answers thank you. What kind of credits woulld be useful? Monetary? Certificates?

It seems counterintuitive though, as the researcher should be self-motivated and find the work self-rewarding.

I wonder if making research compulsory might promote scientific fraud!

The objective of education and research training is to facilitate learning which is a life long obligation of every professional vet or medical doctor mandated by the solemn 'professional Oath'.

So research during training only helping you to search for truth or the reality of life. it does not come through coercion or force. It is an attitude and must come from within.

Jason,

Instead of research perse, I would be more interested to know if nurse residents are able to consume research. How can they relate emerging problems to what is already in current literature. Relate this to local situation, patient preference etc. In other words evidence informed practice or EBP would be a fair approach than expecting residents to undertake research. Only when they cannot find anything related to the problem at hand would research be necessary. Interns and residents work well with clinical guidelines, algorithms, models and frameworks. These can be folded accordion- type, user friendly, pocket size. Something they can peek at as and when possible without taking them away from their present engagement.

The impact assessment on the problem ends up as interesting studies they can share across forums in grand rounds, post clinical conferences, posters, stick-on notes and postings in blogs. I feel that making EBP part of their job description and performance appraisal criteria would encourage them to look into EBP.

I feel expecting residents to do research would be too much of them

Jason,

Perhaps the question is the definition of research and to try to show to the residents that, in fact, many of their daily activities involve some sort of research.

In the area of medicines, medicines utilization and medicines safety, for example, I try to show residents and health professionals that are being trained in our institution:

(1) probably you visit every day many patients that are taking different medicines, and you probably talked with them in order to obtain information for a well-done pharmacological history, so... why not take advantage and study treatment duplicities? Or why not to take advantage of this routine task and quantify non-prescription treatments or herbal remedies in order to quantify their use among patients attended in your emergency room?

(2) during your stay in emergency rooms, many patients will attend with symptoms, lab alterations or diseases produced by previous treatments (i.e., adverse events that prompt hospitalization). These cases are not always apparent, but when doing the differential diagnosis, you will probably identify them. So, why not quantify these cases and describe the clinical manifestations and the involved medicines in order to present the results in a session with other colleagues?

These are just examples in the area of clinical pharmacology, pharmacovigilance or pharmacoepidemiology. To my opinion, these simple activities help to introduce the need to make "research" from all our daily activities. Of course, once a resident get the interest for research, then he/she will naturally participate in much more specific and deep research without any effort. The idea is to begin with very easy "research", to try that they put themselves questions, and that everyday practice become answers to their questions that could be shared with their colleagues.

Hey, Jason. You are very good. Even in busy time of residency, you have some ideas for clinical research. Recently, international, even in domestic clinical trials also want to recruit experienced, and high volume center doctors. So, there are so limited roles for residents. But, I think that you can start from basic things, e.g. studies for medical statistics, regulation of GCP, and roles of IRB. And then you can find some mentors around you who do IIT. For start, IIT will be better than SIT or CIT for you.

If your research activity is within the field of nutrition and/or environmental medicine, may Council for Nutritional and Environmental Medicine (CONEM) be open for a collaboration. Upon request CONEM may be consulted to carry out research (mainly in reference databases), and to help with medical scientific manuscripts. The conditions and the possibility of co-authorship will be discussed individually. See: http://www.conem.org/

It is very essential that during the residency training , they are trained in the fundamentals of research . In our Institute , post graduates who do a 3 year course have to submit a research thesis at the the time of exam . This is the time when they are trained to take up a project & learn the basics of research . In addition , they are made to present papers in national conferences , which gives them confidence & motivates them to take up research later in life after completing their training . It is my belief that every doctor shares his experience in a scientific manner to benefit society . The dataset section available in ResearchGate is an excellent forum for residents to publish their research material , if they have not sent it to a journal for publication .

I think a protected research time is essential for this purpose. Maybe 6 hours each week of working hours during which they are not given any responsibilities except those related to research. Or stating in the residents' contract that they have to come up with one published research paper each year.

Something from our local institution that I recently came across:

http://www.youtube.com/watch?v=9ETYIVU_3Fc&feature=youtu.be

I think research can be included in the curriculum just as the clinical rounds are may be from second years . The importance of Clinical research is undermined in the minds of most of the Clinicaians . A good and novel finding forms the hypothesis for most of the studies. My suggestions are

1 Clinical students should hone the skill of generation of hypothesis. They should they have research rotation where they should discuss or design different models to prove/dissaprove this hypothesis. These models should then go to the ethics rotations and biostatics in order to find and apply suitable model for analysis.

2 They should be able to know by the end of their MBBS how to generate a hypothesis and how to design the research soundly and efectively.

In their residency then because they would already built the acument, research will come automatically, astute clinicians will find something novel everyday.

The best way to promote research activity among residents in an institute is not to interfere and annoy senior faculties interested in research and sensitize the residents about the superior real value intellectual capacity and academic dignity of these faculty.

"Just not keen in the first place" is a concept worth revisiting.

One requirement for an effective ressearcher is caring about the question to the point that it's something they'd do as a hobby. "Disinterested" in research means not having a vested interest in which way the answer comes out. The researcher should be interested in finding the answer, whatever it is.

Where I work, I guide med students and residents through research projects. There's something very satisfying when they start getting worked up over the nuts and bolts of answering a question and the ramifications to the reader. But when that happens, it's a spontaneous thing. I wish I knew how to ignite it in people.

Very well judged and remarked. You are providing excellent and effective guidelines. Hope the like minded community will be benefited and encouraged, but what about the lagging portion? The problem is there. After all in a society, everybody doing research is not so good, but nobody doing research is definitely bad.

Residency is always a busy time and undoubtedly some residents are more inclined (or better trained) to pursue research than others. I suspect that the following factors are most likely to drive the success or failure of residency programs to get their residents engaged in research:

1) Make it clear that an academic project is expected (not optional), and give examples of different types of projects that have been completed by their predecessors.

2) Make it clear that projects should be identified by the end of internship so that time can be devoted to doing the proejct during subsequent years. Emphasize that the timeline is long (IRB approval, etc).

3) Make sure that there are faculty who have the needed skill set to mentor residents, and, if needed, protect some time for select faculty who make it a mission to facilitate resident research.

4) Make it clear that the lead resident will be first author on at least one publication if he/she commits to finishing the project

5) Make sure it's a simple project with a clear hypothesis; avoid the temptation to try to "hit it out of the park" with a grand project; go for a base hit.

6) Avoid the following pitfalls:

a) Doing a study without proper power calculations

b) Doing a study without adequate biostatistical support

c) Having a data collection tool that is too long and cumbersome to use efficiently

d) Having a group of project leads rather than one (ie, the particular resident)

Below are examples publications I have done in which the first authors were trainees (to give an idea of the sorts of research projects and non-research publications that trainees can do):

Girod JP, Brotman DJ. The metabolic syndrome as a vicious cycle: Does obesity beget obesity? Med Hypotheses. 2003;60(4):584-9. PMID: 12615528

Hurbanek JG, Jaffer AK, Morra N, Karafa M, Brotman DJ. Postmenopausal hormone replacement and venous thromboembolism following hip and knee arthroplasty. Thromb Haemost 2004;92(2):337-43 PMID: 15269830

Qadeer MA, Richter JE, Brotman DJ. Hospital-acquired gastrointestinal bleeding outside the critical care unit: risk factors, role of acid suppression, and endoscopy findings. J Hosp Med 2006:1:13-20. PMID: 17219466

Bordeaux BC, Bolen S, Brotman DJ. Beyond cardiovascular risk: the impact of obesity on cancer death. Cleve Clin J Med 2006;73:945-950. PMID: 17044320

Davidson MB, Hix K, Vidt DG, Brotman DJ. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006;166(8):846-852. PMID: 16636209

Girod JP, Brotman DJ. Does altered glucocorticoid homeostasis increased cardiovascular risk? Cardiovascular Res 2004;64:217-26. PMID: 1548568

Davidson MB, Vidt DG, Hoogwerf BJ, Brotman DJ. Relation of diurnal blood pressure variation and triglyceride-to-high density lipoprotein cholesterol ratio in patients without diabetes mellitus. Am J Cardiol 2005;95:123-6. PMID: 15619409

Girod JP, Garcia M, Saunders S, Drinko J, Brotman DJ. Relation of brachial artery reactivity to nitroglycerin and heart rate recovery following exercise in healthy male volunteers. Am J Cardiol 2005;96:447-9. PMID: 16054480

Xu-Cai YO, Brotman DJ, Phillips CO, Michota FA, Tang WH, Whinney CM, Panneerselvam A, Hixson ED, Garcia M, Francis GS, Jaffer AK. Outcomes of patients with stable heart failure undergoing elective non-cardiac surgery. May Clin Proc. 2008;83:280-8. PMID: 18315993

Aggarwal A, Brainard J and Brotman DJ. Spinal metastasis as the initial presentation of a non-secretory glucagonoma. South Med J 2003;96(2):190-3. PMID: 12630646

Wang-Gillam A, Lee RS, Hsi E, Brotman DJ. Acute splenic sequestration resembling sepsis in an adult with hemoglobin SC disease. South Med J 2004;97(4):413-5. PMID: 15108841

Campbell CY, Clark W, Park H, Haq N, Barone BB, Brotman DJ. Usefulness of cystatin C and prognosis following admission for acute heart failure. Am J Cardiol. 2009;104:389-92. PMID: 19616673

Michtalik JH, Yeh HC, Campbell CY, Haq N, Park H, Clarke W, Brotman DJ. Acute changes in N-terminal pro-B-type natriuretic peptide during hospitalization and risk of readmission and mortality in patients with heart failure. Am J Cardiol. 2011;107(8):1191-5. PMID: 21296322

Durand DJ, Feldman LS, Lewin JS, Brotman DJ. Provider cost transparency alone does not impact inpatient imaging utilization. J Am Coll Radiol. 2013;10;108-13. PMID 23273974

Bonilla MF, Kaul DR, Saint S, Isada CM, Brotman DJ. Clinical Problem Solving: Ring around the diagnosis. N Engl J Med 2006;354(18):1937-42. PMID: 16672706

In Brasil, the orthopedic resident at the end of 3rd year of residency program have to submit a research thesis at the the time of exam .The research project is a pre requisite in the 1st year of the period of specialized medical training in our hospital .It's a simple project with a clear hypothesis. The resident have to attend to a huge number of patients but the clinical research is included in the residency program .

Another major obstacle is the seeming lack of interest in research by members of faculty. Having residents with little interest in research leads to faculty with little interest. In Nigeria, rewards for research are confined to promotion in academic settings. Little or no other incentive exists. Moreover, the lack of adequate funding impairs qualitative and meaningful research that can modify practice, which could have been another strong motivation for researchers .

I agree with Bawo James that members of faculty lack interest in research for various reasons . I suggest that low cost technology research , which does not depend on funds would be the solution for many health problems in developing countries & would highlight the problems in practice of health care . I recommend that residents should collect data on various diseases , as they see in their training & develop guidelines based on this experience . Residents who read theory in text books , would realise that practice is different due to lack of adequate diagnostic & treatment facilities , but patients need to be treated utilising empiric guidelines . To publish this experience is vital to help other doctors in management of similar problems . This experience is essential in primary , secondary & tertiary health care of patients . For eg . Dialysis & transplant facilities may not be available to all patients in chronic kidney disease in developing countries , but guidelines have to be made available to manage these patients based on experience . This experience is very essential in common infectious diseases , which is an important cause of morbidity & mortality in developing countries .Therefore , there is an urgent need for applied & analytical research to solve many of the problems of developing countries , rather than basic research which needs a heavy investment , which is just unaffordable & every doctor has to contribute to this , as it is a great prestige to be a doctor in a developing country .

Very interesting comments. I also want to add that there is also a self limiting inertia present in most of the residents that have not performed any research in the past. They might be those stones that may need just a small kick to make them start rolling.

In US, we find a great deal of ACGME oversight for trainees but we dont find any oversight of the trainers. There is no formal faculty training and over the years, clinical teaching is slowly getting devoured by financial constraints faced by the hospitals/teaching programs.

Residents without prior research skills can find a first project intimidating, and often have difficulty formulating an answerable question. For this reason, the American College of Physicians in the USA promotes resident abstract and poster sessions that encourage submissions in multiple areas: traditional biomedical research, quality improvement projects, EBM projects, and clinical case studies. The quality improvement projects and EBM projects can be excellent options to teach basic skills while preparing residents to move toward (and often identify) future investigations.

By writing up a quality improvement project, residents learn to identify a vexing problem, develop an improvement plan, study the results of their intervention, and generate ideas for further changes. They also learn to write up the abstract, prepare a poster, and defend their work. These are high level skills in themselves, yet many residents find them less intimidating to learn than managing IRB approvals, lab work, or clinical data collection. Once skills are practiced in this format, advancement to biomedical research is a smaller leap.

An EBM project is even more simple for novice residents. They simply identify a clinical question based on a clinical case, formulate it using standard EBM technique (PICO,etc), then perform a literature search and summarize their findings. The result is presented in poster format. This is an excellent project for residents who need to hone their skills in how to answer a question, and how to do the necessary literature search to establish the current status of knowledge related to that question.

For those residents ready to take on actual biomedical research, a specific planned curriculum remains helpful. Several resources are available online in the AAMC's MedEdPORTAL, including "How to Write and Abstract of a Research Project" and "How to Formulate a Clinical Question". Setting a defined timeline and mandating visits with a mentor are essential. Residents do not need to be a cog in a jaw-dropping bench work to learn from a research project - they will often learn more about research processes by picking a much smaller project that they can grapple with from formulation through completion and presentation.

Happy teaching everyone!