Integrating Scholarly Activity into Residency Training

Research and scholarly activity are important components of family medicine education.¹ Whereas research refers to the process by which knowledge is tested or developed, scholarly activity usually incorporates a thorough, critical collection of knowledge. Many residency program directors are challenged to include a research curriculum into their already busy family medicine programs.

The Accreditation Council for Graduate Medical Education (ACGME), through the Core Competencies, recently introduced additional required goals for residency programs. Several goals involve incorporating scholarly activity into the patient care experience. Of the 6 core competencies, practice-based learning and improvement and systems-based practice address using scientific evidence to improve patient care. Practice-based learning and improvement require residents to investigate and evaluate their own patient care and improve upon it after appraising and assimilating scientific evidence. Systems-based practice requires that residents show an awareness of and responsiveness to the larger context of health care and are able to use system resources to provide optimal patient care.

James Gill, MD, MPH, research director for the Department of Family and Community Medicine at Christiana Care Health System, offers recommendations consistent with the core competencies. “[W]e should not try to teach all residents how to do research or get them all involved in research projects.” To become “good consumers of research,” Dr. Gill believes residents should be taught skills that allow them to appraise the literature and evidence-based guidelines critically while understanding the basic application of clinical epidemiology. To accomplish these objectives, residents could write evidence-based reviews or undertake “quality-of-care” research by measuring their care against evidence-based practice guidelines.

Scholarship, broadly defined, includes such areas as qualitative/quantitative research, quality improvement, and community-oriented primary care. The AFPRD believes that resident scholarship should be required and endorses the ACGME incorporation of quality improvement as a form of scholarly activity into family medicine residency training.

Used in industry for decades, quality improvement has yet to be fully implemented into the family medicine curriculum. Ogrinc et al² provide a framework of objectives to assist educational leaders when integrating practice-based learning and improvement into a curriculum. Efforts to teach improvement to residents have ranged from including residents on hospital quality improvement committees³ to resident membership on teams to improve the residency itself⁴ to projects without formal quality improvement instruction.⁵ One residency-based, ambulatory family medicine center developed a continuous improvement program that used indicators of diabetes management as measures of quality of care.⁶

As an example of implementing scholarly activity, the Trident Family Medicine Residency Program established the Clinical Scholars Program to foster critical thinking skills for primary care clinicians, specifically in areas of primary care research, evidence-based medicine reviews, and continuous quality improvement initiatives.

After an orientation program in July, second- and third-year residents attend weekly 2-hour sessions to develop and conduct projects. Working in teams, residents choose a project, and each team is required to do a literature evaluation, write a concept paper, present their ideas to the larger group, and submit their work to the internal review board for approval. The program conducts large-group meetings every 6 to 8 weeks for monitoring project progress and for group-learning activities.

In June the residency program hosts a Clinical Scholars Program Research Day, with a 10-minute podium presentation and a 5-minute question-and-answer period for each project. Projects are judged by a 3-member panel, and the best project is recognized. Several projects have been presented at national meetings or published in the primary care literature.

Although this program provides experience in a wide range of scholarly activities for residents, not all residents would benefit from additional instruction in basic research. Dr. Gill believes “[other types of research] should be viewed as an ‘extra’ skill, where residents who are interested get involved, usually by working with a faculty already doing that research.” Dr. Gill notes that the considerable commitment of time to conduct research is no different from the time required to master procedural skills. “Research should not be viewed as a basic skill, but as an extra skill that can be acquired and developed for residents with a particular interest.”

Peter J. Carek, MD, MS

Board of Directors

Association of Family Practice Residency Programs (AFPRD)

AFPRD Representative