Enhancing Engagement in Scholarly Activities and Research in Family Medicine Residency Programs

 
Tips for Engaging and
Exciting Residents
(and faculty)
in Scholarship and Research,
Part 2:
Creative QI & Scholarship
Activity Curricula
 
Ryan Gilles, MD, Kootenai Clinic Family Medicine Residency of Coeur d’Alene
Elizabeth Paddock, MD, Family Medicine Residency of Western Montana
Morhaf Al Achkar, MD, PhD, University of Washington Family Medicine Residency
 
POLL
 
Does your program have a formal scholarly activity curriculum?
Achieving scholarly activity requirements for residents in my program is…
Do residents in your program participate in research projects?
What is the most significant challenge your program faces in engaging residents
in scholarly activity?
ACGME/RRC REQUIREMENTS
 
Residents
2 scholarly works during residency
At least one must be a quality improvement project
Faculty – new ACGME wording
At least 3 of the following:
Research, peer reviewed grants; QI and/or patient safety initiatives; Systematic reviews, meta-analysis, review articles;
chapters in medical text books or case reports; creation of curricula, evaluation tools, didactic educational activities, or
electronic educational materials; contribution to professional committees, educational organizations, or editorial boards;
innovations in education
Dissemination
For program as a whole, over a 5 year interval
Faculty participation in grand rounds, posters, workshops, QI presentations, podium presentations, grant leadership, non-
peer-reviewed print/electronic resources, articles, or publications, book chapters, text books, webinars, service on
professional committees, serving as a journal reviewer, journal editorial board member, or editor, peer-reviewed
publication
No update from FM RRC – still states 2 per faculty on average over 5 years
 
THE IMPORTANCE OF RESEARCH IN FAMILY
MEDICINE
 
“Research in primary care is essential because clinical care
must be based on research evidence, and the evidence base
for the majority of care for the population cannot be
generated only through animal studies or laboratory or
hospital-based research. Despite the size and importance of
primary care in delivering health care, the research output has
been relatively limited.”
 
 
Carek P, Mainous A. 
The State of Resident Research in Family Medicine: Small but
Growing. 
Ann Fam Med 2008;6(suppl 1):s2-s4.
 
COMMON CHALLENGES
FROM WPRN PRE-CONFERENCE
 
TIME
MONEY
Interest and enthusiasm
Follow through
Siloes
Linking residents and faculty for
projects
IRB
Meeting “minimums” only
Tracking projects
When to say “no”
 
This Photo
 by Unknown Author is licensed under 
CC BY-
SA-NC
 
BARRIERS TO RESEARCH IN
RESIDENCY
 
1.
Lack of Resident Interest
2.
Resident Time
3.
Lack of Mentors
4.
Faculty Time
5.
Lack of Research Curriculum
6.
Lack of Funding
7.
Inadequate Research Skills
among Residents
 
Rothberg MB. 
Overcoming the obstacles to
research during residency: what does it take?.
JAMA 2012; 308 (21):2191-2192.
 
The majority of family medicine
residencies did not receive
grant funding for research and
reported that 
time
 and
money
 were the most
significant barriers to research.
 
Young R, et al. 
Research Funding and
Mentoring in Family Medicine Residencies.
Fam Med 2007;39(6):410-8.
 
Possible solutions from the literature:
Keys to Successful Research in Family Medicine Residency Education
 
1) Program director support
2) Time – for faculty and residents
3) Faculty involvement in research
4) A research curriculum/journal club
5) An easily accessible research professional
6) Opportunities for residents to present their research
7) A research/scholarly activity committee
1) DeHaven M, Wilson G, O
Connor-Kettlestrings P. 
Creating a
research
 
culture: what we can learn from residencies that are successful
in
 
research
. Fam Med 1998;30:501-507.
2) Winter R. 
Leading Successful Residency Research
.  Ann Fam Med
2003; 1: 183.
 
CASE STUDY #1 – FMRWM (ELIZABETH)
 
Overview of QI at the FMRWM
6 didactic sessions spread out over the academic year.   3 faculty involved in oversight.
At each session we briefly cover a QI topic/skill, then allow time for residents to work
on QI projects.
R1: Individual behavior/workflow/wellness theme.  May join up with an R2/R3 group if
strong interest in a particular project.
R2: A clinical project that ideally will meet the ABFM Performance Improvement
requirement
R3:  A QI project of their choosing
R2/R3s may work in groups of 2 or 3.
Spring Scholarly Activity Showcase
“Scholarly Activity and QI Work”  annual publication.
 
QI AT FMRWM-
GOALS OF THE QI CURRICULUM
 
Our aim is not necessarily success but rather exposure to the QI process.
Residents choose their topics.  Huge variability in what is addressed.
We do not want this to feel like extra work.
Because of limited time we aim to make these really tiny projects.
Majority of our teaching is spent on SMART aim statements.   Some on
measures.
1:1 guidance and suggestions on projects available during protected QI time.
We have tried to partner with QI interests/growth areas at Partnership Health
Center (PHC) our clinical training site.
 
FMWRM
DETAILS OF THE ANNUAL PUBLICATION OF QI AND
SCHOLARLY ACTIVITY WORK.
 
Final product:   For R1/R2/R3
 QI Write up using QI abstract template
In addition R3s also provide a write up of scholarly activity work completed over
the past 3 years.
 
QI WRITE UP TEMPLATE
 
Project Title
Problem
Aim statement
Key measures for improvement
Data gathering process
Analysis and Interpretation
Strategies for change
Effects of change
Lessons learned
 
SCHOLARLY ACTIVITY WORK SUMMARY
 
SUMMARY
Title of project
Details of the project
Outcome
Reflections on the project.
 
SCHOLARLY ACTIVITY SHOWCASE
R3s take ~7-10 minutes to present on their QI and SA work and answer questions.
All residents, core faculty, PHC providers, PHC leadership and QI team,  and
community preceptors are invited to attend.
 
2018-2019 R2/R3 QI PROJECTS
 
CHALLENGES
 
2018-2019:   Time period was 6 months.  This year have expanded curriculum
out 9 months (still just 6 sessions) to allow more time for data collection.
It takes about 3 sessions to finalize the aim statement.  .
R1 wellness theme: some pushback from a few R1s that we were “taking one
thing that brought them joy and making it work”.
R2s and ABFM QI requirements.  Currently encouraging use of the Performance
Improvement “clinical pathway” write up.
Have not yet pursued Respip approval
Partnering with PHC objectives.
Confusion over QI vs Scholarly Activity requirements.
Not a comprehensive QI curriculum.
Prioritizing what skills to teach and tools to use?
 
SUCCESSES
 
Resident buy-in
Some really valuable contributions
Several residents building on projects from the prior year (PDSA cycle #2)
Sharing of the great work residents are doing with our community.
Tiny projects model probably more realistic for most in the future after
graduation.
 
CASE STUDY #2 – UWFMR (MORHAF)
 
Residency Expectations
 
Learning how to evaluate and apply research
Complete HDA
Core skill I&2
Master critical appraisal
Journal clubs
Complete a scholarly (non-QI) project
Scholarly blocks
R1 3-4 weeks
R2 6 elective weeks;
R3 12 elective weeks; time during R3 curriculum?
Complete a quality improvement (QI) project
 R3 curriculum
 
INTERNS’ SCHOLARLY WEEKS
 
Intro to scholarly work (Scholarly work I)
Early to mid year for R1
Objectives
Explore scholarship opportunities in residency
Reflect on residents’ previous experiences in scholarship
Conceptualizing individual scholarship projects
Identifying possible mentors
Share ongoing projects
1-2 months prior, faculty champion seeks research faculty input on
ongoing projects that could include residents
Invite researchers to talk to residents (30 min zoom conversations)
Develop repository of projects
 
INTERNS’ SCHOLARLY WEEKS
 
Second block (Scholarly Work II)
Second half 
of intern year
Objectives
Check in on progress with scholarly work
Problem solve
Have time to work on projects including HDA
 
CHECK IN
 
CCC and advisor meetings (Q6 months)
Scholarly week block II (around Core skill III)
2 hours session to check in
Troubleshoot problems
Give advice
Medical home 
month (R2)
2 hours session to check in
Department fair
Submit WIP poster by second year?
WIP Wednesday
3
rd
 Wednesday
R2&3 to present their work
R3 Curriculum
Provide time to work on scholarly projects and QI
2 hours to check in when all residents are around
 
A PIPELINE FOR COLLABORATIVE
PROJECTS WITH RESEARCHERS
 
Annual solicitation of projects around interns’ scholarly block
Longitudinal conversations on the third Wednesday
“As they come” projects
Collaborative funded projects
 
ANNUAL SOLICITATION OF PROJECTS
 
1-2 month prior to interns’ scholarly blocks
Brief Project Description
Possible Resident Role
Time commitment needed
Links to Further Reading
Available time for first meeting
Consider revising sheet with researchers
Share 5-6 projects with interns
Schedule few 30 minutes conversations during scholarly blocks
 
 
LONGITUDINAL CONVERSATIONS ON THE
THIRD WEDNESDAY—LED BY RESEARCHERS
 
Objectives of presentations are threefold
Teach a method of research
Showcase a project
Invite residents and residency faculty to join
Dates and lists of presenters will be developed in collaboration with
research section
July: intro to research, scholarship, or writing
August-June: researcher presentations
 
“AS THEY COME” PROJECTS
 
WPRN projects
Champion to share with faculty in next faculty meeting as announcement
Champion to share with residents in next Wednesday as 5 minutes
announcement
Email goes out to both group
 
LEARNING CRITICAL APPRAISAL (EBM)
 
Either
 Online modules (Preferred)
YouTube videos on critical appraisal (4)
4 articles and 4 working sheets
Scholarly work II
Expectations are to complete 2
Or
 1-2 sessions during 3
rd
 Wednesday
Therapy (RCT)
Diagnosis
Prognosis
Etiology
Or combination of both
Practicing by running journal club (JC)
Develop a structure for leading JC discussions
Validity, importance of results, applicability
 
QUESTIONS? DISCUSSION?
 
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Explore strategies and challenges in promoting scholarly activities and research participation among residents and faculty in family medicine residency programs. Learn about ACGME/RRC requirements, importance of research in primary care, and creative QI and scholarship curricula. Discover insights on engaging residents in scholarly activities to enhance evidence-based clinical care in family medicine.


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  1. Tips for Engaging and Exciting Residents (and faculty) in Scholarship and Research, Part 2: Creative QI & Scholarship Activity Curricula Ryan Gilles, MD, Kootenai Clinic Family Medicine Residency of Coeur d Alene Elizabeth Paddock, MD, Family Medicine Residency of Western Montana MorhafAl Achkar, MD, PhD, University of Washington Family Medicine Residency

  2. POLL Does your program have a formal scholarly activity curriculum? Achieving scholarly activity requirements for residents in my program is Do residents in your program participate in research projects? What is the most significant challenge your program faces in engaging residents in scholarly activity?

  3. ACGME/RRC REQUIREMENTS Residents 2 scholarly works during residency At least one must be a quality improvement project Faculty new ACGME wording At least 3 of the following: Research, peer reviewed grants; QI and/or patient safety initiatives; Systematic reviews, meta-analysis, review articles; chapters in medical text books or case reports; creation of curricula, evaluation tools, didactic educational activities, or electronic educational materials; contribution to professional committees, educational organizations, or editorial boards; innovations in education Dissemination For program as a whole, over a 5 year interval Faculty participation in grand rounds, posters, workshops, QI presentations, podium presentations, grant leadership, non- peer-reviewed print/electronic resources, articles, or publications, book chapters, text books, webinars, service on professional committees, serving as a journal reviewer, journal editorial board member, or editor, peer-reviewed publication No update from FM RRC still states 2 per faculty on average over 5 years

  4. THE IMPORTANCE OF RESEARCH IN FAMILY MEDICINE Research in primary care is essential because clinical care must be based on research evidence, and the evidence base for the majority of care for the population cannot be generated only through animal studies or laboratory or hospital-based research. Despite the size and importance of primary care in delivering health care, the research output has been relatively limited. Carek P, Mainous A. The State of Resident Research in Family Medicine: Small but Growing. Ann Fam Med 2008;6(suppl 1):s2-s4.

  5. COMMON CHALLENGES FROM WPRN PRE-CONFERENCE TIME MONEY Interest and enthusiasm Follow through Siloes Linking residents and faculty for projects IRB Meeting minimums only Tracking projects When to say no This Photo by Unknown Author is licensed under CC BY- SA-NC

  6. BARRIERS TO RESEARCH IN RESIDENCY 1. Lack of Resident Interest 2. Resident Time The majority of family medicine residencies did not receive grant funding for research and reported that time and money were the most significant barriers to research. 3. Lack of Mentors 4. Faculty Time 5. Lack of Research Curriculum 6. Lack of Funding 7. Inadequate Research Skills among Residents Young R, et al. Research Funding and Mentoring in Family Medicine Residencies. Fam Med 2007;39(6):410-8. Rothberg MB. Overcoming the obstacles to research during residency: what does it take?. JAMA 2012; 308 (21):2191-2192.

  7. Possible solutions from the literature: Keys to Successful Research in Family Medicine Residency Education 1) Program director support 2) Time for faculty and residents 3) Faculty involvement in research 4) A research curriculum/journal club 5) An easily accessible research professional 6) Opportunities for residents to present their research 7) A research/scholarly activity committee 1) DeHaven M, Wilson G, O Connor-Kettlestrings P. Creating a researchculture: what we can learn from residencies that are successful inresearch. Fam Med 1998;30:501-507. 2) Winter R. Leading Successful Residency Research. Ann Fam Med 2003; 1: 183.

  8. CASE STUDY #1 FMRWM (ELIZABETH) Overview of QI at the FMRWM 6 didactic sessions spread out over the academic year. 3 faculty involved in oversight. At each session we briefly cover a QI topic/skill, then allow time for residents to work on QI projects. R1: Individual behavior/workflow/wellness theme. May join up with an R2/R3 group if strong interest in a particular project. R2: A clinical project that ideally will meet the ABFM Performance Improvement requirement R3: A QI project of their choosing R2/R3s may work in groups of 2 or 3. Spring Scholarly Activity Showcase Scholarly Activity and QI Work annual publication.

  9. QI AT FMRWM- GOALS OF THE QI CURRICULUM Our aim is not necessarily success but rather exposure to the QI process. Residents choose their topics. Huge variability in what is addressed. We do not want this to feel like extra work. Because of limited time we aim to make these really tiny projects. Majority of our teaching is spent on SMART aim statements. Some on measures. 1:1 guidance and suggestions on projects available during protected QI time. We have tried to partner with QI interests/growth areas at Partnership Health Center (PHC) our clinical training site.

  10. FMWRM DETAILS OF THE ANNUAL PUBLICATION OF QI AND SCHOLARLY ACTIVITY WORK. Final product: For R1/R2/R3 QI Write up using QI abstract template In addition R3s also provide a write up of scholarly activity work completed over the past 3 years.

  11. QI WRITE UP TEMPLATE Project Title Problem Aim statement Key measures for improvement Data gathering process Analysis and Interpretation Strategies for change Effects of change Lessons learned

  12. SCHOLARLY ACTIVITY WORK SUMMARY SUMMARY Title of project Details of the project Outcome Reflections on the project. SCHOLARLY ACTIVITY SHOWCASE R3s take ~7-10 minutes to present on their QI and SA work and answer questions. All residents, core faculty, PHC providers, PHC leadership and QI team, and community preceptors are invited to attend.

  13. 2018-2019 R2/R3 QI PROJECTS Using a huddle check list for improved clinic team efficiency. Naloxone prescribing practices for patients at risk of overdose Medicare Wellness Exam (PHC area of focus) BMI Counseling Developmental Screening in WCCs (PHC area of focus) Nursing triage protocols Improved Contraception Access Optimize OMT in-house referrals (PHC area of focus) Lab workflow (PHC QI project) Improving continuity of care Improving Hep C screening for 1945-1965 cohort (Kalispell project) Improving ASQ screening (Kalispell project)

  14. CHALLENGES 2018-2019: Time period was 6 months. This year have expanded curriculum out 9 months (still just 6 sessions) to allow more time for data collection. It takes about 3 sessions to finalize the aim statement. . R1 wellness theme: some pushback from a few R1s that we were taking one thing that brought them joy and making it work . R2s and ABFM QI requirements. Currently encouraging use of the Performance Improvement clinical pathway write up. Have not yet pursued Respip approval Partnering with PHC objectives. Confusion over QI vs Scholarly Activity requirements. Not a comprehensive QI curriculum. Prioritizing what skills to teach and tools to use?

  15. SUCCESSES Resident buy-in Some really valuable contributions Several residents building on projects from the prior year (PDSA cycle #2) Sharing of the great work residents are doing with our community. Tiny projects model probably more realistic for most in the future after graduation.

  16. CASE STUDY #2 UWFMR (MORHAF) Residency Expectations Learning how to evaluate and apply research Complete HDA Core skill I&2 Master critical appraisal Journal clubs Complete a scholarly (non-QI) project Scholarly blocks R1 3-4 weeks R2 6 elective weeks; R3 12 elective weeks; time during R3 curriculum? Complete a quality improvement (QI) project R3 curriculum

  17. INTERNS SCHOLARLY WEEKS Intro to scholarly work (Scholarly work I) Early to mid year for R1 Objectives Explore scholarship opportunities in residency Reflect on residents previous experiences in scholarship Conceptualizing individual scholarship projects Identifying possible mentors Share ongoing projects 1-2 months prior, faculty champion seeks research faculty input on ongoing projects that could include residents Invite researchers to talk to residents (30 min zoom conversations) Develop repository of projects

  18. INTERNS SCHOLARLY WEEKS Second block (Scholarly Work II) Second half of intern year Objectives Check in on progress with scholarly work Problem solve Have time to work on projects including HDA

  19. CHECK IN CCC and advisor meetings (Q6 months) Scholarly week block II (around Core skill III) 2 hours session to check in Troubleshoot problems Give advice Medical home month (R2) 2 hours session to check in Department fair Submit WIP poster by second year? WIP Wednesday 3rd Wednesday R2&3 to present their work R3 Curriculum Provide time to work on scholarly projects and QI 2 hours to check in when all residents are around

  20. A PIPELINE FOR COLLABORATIVE PROJECTSWITH RESEARCHERS Annual solicitation of projects around interns scholarly block Longitudinal conversations on the third Wednesday As they come projects Collaborative funded projects

  21. ANNUAL SOLICITATION OF PROJECTS 1-2 month prior to interns scholarly blocks Brief Project Description Possible Resident Role Time commitment needed Links to Further Reading Available time for first meeting Consider revising sheet with researchers Share 5-6 projects with interns Schedule few 30 minutes conversations during scholarly blocks

  22. LONGITUDINAL CONVERSATIONS ON THE THIRD WEDNESDAY LED BY RESEARCHERS Objectives of presentations are threefold Teach a method of research Showcase a project Invite residents and residency faculty to join Dates and lists of presenters will be developed in collaboration with research section July: intro to research, scholarship, or writing August-June: researcher presentations

  23. AS THEY COME PROJECTS WPRN projects Champion to share with faculty in next faculty meeting as announcement Champion to share with residents in next Wednesday as 5 minutes announcement Email goes out to both group

  24. LEARNING CRITICAL APPRAISAL (EBM) Either Online modules (Preferred) YouTube videos on critical appraisal (4) 4 articles and 4 working sheets Scholarly work II Expectations are to complete 2 Or 1-2 sessions during 3rd Wednesday Therapy (RCT) Diagnosis Prognosis Etiology Or combination of both Practicing by running journal club (JC) Develop a structure for leading JC discussions Validity, importance of results, applicability

  25. QUESTIONS? DISCUSSION?

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