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With the 80-hour weekly cap on resident hours implemented in 2003, resident publications in peer-reviewed journals have increased substantially (Clin Orthop Relat Res. 2010;468:2278–2283). But are residents toughing it out on their own when it comes to conducting research, or do training programs now give them relevant instruction in doing productive research, and the confidence that comes with it?
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September 2019A 2015 study of third-year psychiatric residents found that when given an interactive, web-enhanced course to provide the theoretical and methodological tools for conducting and reporting systematic reviews and meta-analyses, participants reported a statistically significant increase in their confidence to conduct systematic reviews and meta-analyses (J Grad Med Educ. 2015;7:445–450). During the 36-week course, these residents also saw a boost in their academic productivity, which included 11 conference presentations and four peer-reviewed published manuscripts, two of them award-winning.
Cristina Cabrera-Muffly, MD, an otolaryngologist and residency program director at the University of Colorado (CU) in Aurora, said otolaryngology residency programs are doing a good job of teaching research skills. “I’ve been a part of several programs, whether in training or being employed there, and all of these programs have given residents a good research background.”
Protected Research Time
The Accreditation Council for Graduate Medical Education (ACGME) currently requires a minimum of three months of protected time for otolaryngology residents to conduct research, though many programs give their residents more. ACGME also requires that programs provide instruction in research methods and design outcome assessments, and they recommend that the research experience culminate in a manuscript that is ready to be submitted for publication.
Research training, however, can vary from institution to institution, with some programs geared toward training otolaryngologists in private practice and others geared toward those who want to become academics or researchers. Dr. Cabrera-Muffly said some programs go through changes over the years that may include more of an emphasis on research.
Researchers of a 2017 study found that the otolaryngology residency programs they surveyed do value research, as evidenced by financial support provided and requirements beyond the ACGME minimum (Otolaryngol Head Neck Surg. 2017 Jun;156(6):1119-1123). Of the 98 allopathic otolaryngology training program directors surveyed anonymously online, 53% managed programs with a dedicated research coordinator, 58% ran programs with basic science lab space and financial resources for statistical work, 67% had residents with two to three active research projects at any given time, and 63% had resident research requirements beyond the ACGME mandate of preparing a “manuscript suitable for publication” prior to graduation.
At the CU School of Medicine, otolaryngology residents get four months of dedicated, protected research time. Before their four-month block begins, however, they are expected to find a topic and a research mentor, as well as gain Institutional Review Board approval. “What we try to do is get them set up so that they can hit the ground running when that four months starts,” said Dr. Cabrera-Muffly. During their protected time, CU medical school residents conduct experiments and collect data. Most draft their manuscripts after the protected block is finished.
Seven years ago, CU School of Medicine began its grant-supported T32 institutional training program for pre-doctoral and post-doctoral fellows with projects related to otolaryngology, including hearing/balance, taste/smell, communication, and head and neck cancer. These T32s, usually one per year, receive an additional two years of research training. They are assigned a basic science research mentor who supervises them in a laboratory environment and a clinical co-mentor who provides experiences such as participation in a clinical research study or shadowing in a clinical environment.
While programs dedicated to training private practice clinicians may become more academically oriented, those with T32s usually remain dedicated to training clinician scientists, said Dr. Cabrera-Muffly.
Some otolaryngology programs, like the Hospital of the University of Pennsylvania in Philadelphia, attract residents who are more academically oriented than others. “More than 70% of our residents enter fellowship training and more than half enter academic jobs,” said Michael J. Ruckenstein, MD, MSc, an otorhinolaryngologist and director of residency training and education at the hospital. “This is very different than the national mean, which is about 25%.”