Research in Pediatric Residency Programs

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Research

in Pediatric

Residency

Programs

PEDIATRICS Vol. 97 No. I January 1996 71

Ben H. Brouhard, MD*; Wilma Doylel; Jos#{233}Aceves, MIY; and Michael

J. McHugh,

MD*

ABSTRACT. Background and Objectives. We have

re-quired residents in pediatrics at the Cleveland Clinic Foundation to give research presentations since 1989; this article reviews our experience with this program.

Addi-tionally, we sought to determine how many other

accred-ited pediatric programs in the United States also require this.

Methods. Retrospective review of the Cleveland Clinic program; descriptive statistics of other United States residency programs, obtained by questionnaire.

Results. Pediatric residents at the Cleveland Clinic have given 108 research presentations since 1989, and have developed 33 (30.5%) of them into manuscripts or abstracts. We mailed questionnaires to 215 pediatric res-idency program directors and received responses from 177 (82%). Of these, 48 (27%) indicated their programs had a research requirement; residents could present their findings in departmental meetings or submit an abstract or manuscript to a professional society or journal. Re-spondents cited several bathers to research: residents are too busy, there are too few faculty members to mentor them, financial resources are limited, and there is no residency review committee requirement.

Conclusions. Even though only approximately one fourth of the pediatric residency programs in the United States require research, we feel it is worthwhile ex-perience. Despite barriers, residents can and do per-form research and publish their findings. Pediatrics

1996;97:71-73; pediatric residency programs, research.

Previous studies3 have indicated that medical

students and residents who perform research are

more competitive as candidates for future training

than those who do not, and the experience may

influence their choice of career. No studies to date

have determined how many pediatric residency

pro-grams include a research requirement. Stiehm4 has

indicated that research may play an important role in

residency programs for a variety of reasons. Winters

reported that the Department of Pediatrics at North-western University has had a program of resident

research for over 10 years, and more than 30% of the

presentations have been published.

The Department of Pediatrics at the Cleveland

Clinic Foundation instituted a research requirement

for its residents in 1989. This article is part of an

ongoing evaluation of this program. In addition, we

From the *jon of Pediatrics, the Department of Nephrology and

Hypertension, the §Research Institute, Department of Molecular

Cardiol-ogy, and the IDivision of Education, Cleveland Clinic Foundation,

Cleveland, OH.

Received for publication Dec 5, 1994; accepted Feb 21, 1995.

Reprint requests to (B.H.B.) Cleveland Clinic Foundation, Department of

Pediatrics, 9500 Euclid Avenue, Cleveland, OH 44195.

PEDIATRICS (ISSN 0031 4005). Copyright C 1996 by the American

Acad-emy of Pediatrics.

wanted to find out how many other pediatric

resi-dency programs had such a requirement.

METHODS Cleveland Clinic Program

Since June 1989, all residents in the Department of Pediatrics at

the Cleveland Clinic Foundation have been required to give one research presentation each year. First-year residents may perform

a literature review, but second- and third-year residents must present original research. All presentations take place on one day near the end of the academic year (“Research Day”). Each resident

is allotted 10 minutes for an oral presentation and 5 minutes for

discussion. Residents in the combined internal medicine-pediatric program must give two presentations during their 4 years of

residency.

The residents must choose a mentor for their projects from any of the full-time staff at the Foundation. Funding for projects comes

from the mentors’ funds, from departmental funds, and from the Foundation. Residents are encouraged to submit their projects for presentation at regional and national research meetings, and, if

appropriate, for publication as articles in professional journals.

Pediatric Residency Questionnaire

We designed a questionnaire and sent it to the directors of all

215 pediatric residency programs accredited as of 1993. This

project was approved by the Institutional Review Board of the Cleveland Clinic Foundation.

RESULTS

Cleveland Clinic Foundation

Over the last 6 years, 54 pediatric residents (six to

eight each year) and internal medicine-pediatric

res-idents (four each year) have given a total of 108

presentations, comprising 46 retrospective chart

re-views, 25 prospective studies, 18 literature reviews,

six

patient reports, and three laboratory-based

stud-ies. Thirty-three (30.5%) of these were subsequently

written up as manuscripts or abstracts. Thirteen

ab-stracts have been presented at regional meetings

(an-other

two

were read by title only), and three were

presented at national meetings. Fifteen were

devel-oped into manuscripts (each presentation is counted only once, as either an abstract or a manuscript.

Of the 36 residents who completed their training

since the institution of the research program, exactly

half entered fellowships and half entered private

practice.

Other Pediatric Programs

Of the 215 questionnaires sent out, 177 (82%) were

returned within 6 months. Forty-eight (27%) of the

respondents indicated their programs had a research

requirement, and 129 (73%) indicated there was no

such requirement. Thirty-nine (81%) of the programs

with a research requirement were associated with medical schools, as were 113 (88%) with no research

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72 RESEARCH IN PEDIATRIC RESIDENCY PROGRAMS requirement The distribution of programs by size is

listed in Table 1. Of the programs that required a

research project, 38 required residents to perform

one project; one required two projects, and five re-quired three (one director did not answer this ques-tion). The type of research performed, the

documen-tation required, and the format are listed in Table 2.

We also asked the program directors how many

presentations had been given over the last 3 years. Six

programs were just getting started and had no resident

presentations, and one respondent did not answer the

question. In the 40 remaining programs that had a research requirement, 914 presentations were given

from 1990 through 1993. The number of presentations

given at each institution in the entire 3-year period

ranged from I to 72. In 30 programs (75%), some of the

residents subsequently submitted their findings in

ab-stracts; the number of abstracts ranged from I to 51. In

26 programs (65%), between 1 to 12 manuscripts

re-sulted from these presentations.

Respondents from programs requiring research

cited several impediments making it difficult for

res-idents to perform research: the residents were too

busy, there were too few faculty members

experi-enced in research to serve as mentors, and financial

and physical resources were limited (Table 3). Lack of interest among the faculty and administrative

bar-riers were cited by only a minority of respondents.

Forty-three (89%) of these 48 respondents felt that

research by residents was generally encouraged at

their institutions.

Twenty-five directors of programs not requiring re-search also answered these same questions. Eighteen

indicated the residents were too busy; the next most

commonly cited impediment was limited financial

re-sources. Lack of a residency review committee

require-ment was also mentioned by about haM of the

respon-dents (Table 3).

As for staff research, 44 (96%) of 46 directors of

programs requiring resident research felt it was im-portant, 41 (89%) said it was encouraged at their institution, but only 23 (50%) indicated that it was required. For programs not requiring resident

re-search, the percentages were very similar: 123 (97%)

of 127 respondents considered staff research

impor-tant, an equal number said their institutions

encour-aged it, and 61 (48%) said it was required.

TABLE 1. Number of Pediatric Residency Pr

quire Research, by Size of Program

ograms That

Re-Programs Programs

That That Do

Require Not Require

Research Research

No. (%) No. (%)

Small programs (10 or fewer 29 (60) 62 (48)

residents)

Medium-sized programs (ii 14 (29) 44 (34)

to 20 residents)

Large programs (more than 5 (10) 23 (18)

20 residents)

Total 48 (100) 129 (100)

TABLE 2. Type of Research Projects Performed by Pediatric Residents in the 48 Programs That Required Research, 1989 Through 1993

No. of Programs in

Which This Occurred

Type of projects

Retrospective chart reviews 40

Prospective human studies 40

Patient reports 37

Uterature reviews 31

Basic laboratory projects 27

Where projects were presented

Presentation to department 38

Grand rounds I 7

Research day 17

Research seminar 15

Abstracts submitted for presentation 19

Manuscripts submitted for publication 19

TABLE 3. Barriers to Research Cited By Residency Program

Directors

No. of Respondents Citing

These Bathers

Programs Programs That That Require Do Not Require

Research Research

(n=48) (n=25)

Residents too busy 30 18

Limited research-trained faculty 9 4

to mentor the residents

Limited physical and financial 29 15

resources

Limited faculty interest 8 3

Administrative barriers 3 1

No RRC requirement 0 10

RRC, residency review committee.

DISCUSSION

As noted by Stiehm,4’6 research in pediatrics may

have many rewards not found in other areas: close

association with children and parents, the potential

to make a large impact on health care, and less

competition for funding. Pediatric residents working on research projects learn the value of careful and controlled observation, acquire new skills, come to appreciate the value of persistence, and learn about themselves and the value of clear, concise writing and discourse.

The value of research during early years of

train-ing has been demonstrated in other disciplines as

well. Hirthler at al’ reported that general surgical

residents who had research experience had a

signif-icantly better chance of entering desired pediatric

surgical residency programs. Sanders et al7 indicated

that residents in emergency medicine programs who

wanted to obtain academic positions felt their

expo-sure to both research and appropriate research role

models was inadequate. Further, signfficantly more

of those desiring an academic career had performed

research in medical school and residency and had

written research papers than had residents who

planned to enter private practice. Hilman et al2

noted that radiology residents who chose research

careers typically had published manuscripts, had

ac-cess to grant funds, and had used computers in

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ARTICLES 73

medical school or postgraduate training. In a

corn-parison of the curricula of three medical schools,

Segal et altt found that graduates of medical schooLs

that included research in the curriculum were more

likely to subsequently engage in research at the

post-graduate level. Thus, research exposure early in

one’s medical career can influence future career

choices. Further, research during residency may

cre-ate interest in an academic career and may make the

resident more competitive for fellowship positions.

Bland and Schmitz9 reported that productive

re-searchers tend to have benefited from mentoring,

good study habits, peer support, sufficient time, and,

most important, a supportive environment early in

their careers.

Our data indicate that approximately one fourth of

pediatric residency programs in the United States

have a research requirement. We feel it important to

require research and not merely to encourage it, as the

research may not actually be performed unless it is

required, despite good intentions. As the program

directors noted, the residents’ schedule often does

not conveniently allow for research. However, if

pe-diatric research is to succeed and thrive, it must be

encouraged as early as possible. The data of Hillman

et al2” and Bland and Schmitz support the notion

that physicians who perform research early in their

careers continue to do so later.

To succeed in research, pediatric residents need

mentors, support (financial, moral, peer, and

depart-mental), and an environment that encourages

re-search. Programs that have a research requirement

generally provide these things. For example, at the

Cleveland Clinic, the entire faculty has supported the residents in their research activity, not only by

serv-ing as mentors, but also by attending the residents’

presentations. We feel that this experience

encour-ages those residents who may be considering

aca-demic careers, and provides them with a foundation

to do so. It can also have benefits for those who plan

to enter private practice. We would encourage any

pediatric residency program that has sufficient time

and resources to adopt such a requirement.

REFERENCES

1. Hirthler MA, Click PL, Hassett Jr JM, et aL Comparative analysis of

successful and unsuccessful candidates for the pediatric surgical

match-ing program. IPediatr Surg. 199227:142-148

2. Hillman BJ, Lajardo LL, Witzke DB, Cardenas D, Irion M, FUlginiti JV.

Influences affecting radiologists’ choices ofacademic or private practice

careers. Radiology. 1990;174:561-564

3. Hillman BJ, Fajardo LL, Witzke DB, Cardenas D, hion M, FUlginIti N.

Factors influencing radiologists to choose research careers. Invest Radio!.

198724:842-848

4. Stiehm ER. Some of my best clinical pediatricians are researchers. Am I Dis Child. 1989;143:521

5. Winter RJ. Research during residency. Am IDis Child. 1989;143:521

6. Stiehm ER. Growth and development ofpediatric research. Pediatr Res.

1985;19:593-598

7. Sanders AR, FU1ginitiN, Witzke DB. Factors influencing resident career

choices in emergency medicine. Ann Emerg Med. 1992;21:47-52

8. Segal 5, Uoyd T, Houts PS, Stillinan PL, Jungas RL, Greer ifi RB. The

association between students’ research involvement in medical school

and their postgraduate medical activities. Acad Med. 1990;65:530-533 9. Bland g, Schmitz CC. Characteristics of the successful researcher and

implications for faculty development. IMed Educ. 1986;61:22-31

THE

CASE

FOR SIMPLICITY

OF DESIGN

What isn’t there can’t break.

Dennett DC. Darwin’s Dangerous Idea. New York, NY: Simon & Schuster; 1995.

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1996;97;71

Pediatrics

Ben H. Brouhard, Wilma Doylel, José Aceves and Michael J. McHugh