Use of a problem-based learning discussion format to teach anesthesiology residents research fundamentals

Tetsuro Sakai; Patricia L Karausky; Shannon L Valenti; Susan L Sandusky; Sandra C Hirsch; Yan Xu

doi:10.1016/j.jclinane.2013.04.008

. Author manuscript; available in PMC: 2014 Sep 1.

Published in final edited form as: J Clin Anesth. 2013 Aug 17;25(6):10.1016/j.jclinane.2013.04.008. doi: 10.1016/j.jclinane.2013.04.008

Use of a problem-based learning discussion format to teach anesthesiology residents research fundamentals^{☆,☆☆,★}

Tetsuro Sakai ^a,^*, Patricia L Karausky ^b, Shannon L Valenti ^b, Susan L Sandusky ^b, Sandra C Hirsch ^a, Yan Xu ^a

PMCID: PMC3843226 NIHMSID: NIHMS513519 PMID: 23965212

Abstract

Study Objective

To present a new research problem-based learning discussion (PBLD) conference and to evaluate its effect on residents.

Design

Retrospective observational study of resident education before and after implementation of a research PBLD.

Setting

Large U.S. academic anesthesiology department.

Subjects

93 anesthesiology residents with research PBLD exposure in the academic year (AY) 2010 and AY 2011, and 85 residents without research PBLD exposure in AY 2008 and AY 2009.

Measurements

Since AY 2010, a PBLD format has been used to teach residents clinical research fundamentals. The annual 90-minute PBLD addressed residents’ perceived barriers to research and introduced research resources available via the Clinical and Translational Science Institute (CTSI). Data recorded were: 1) number of residents who made CTSI consultation solicitations as a new investigator, and 2) number of new research projects proposed by the residents and designed with CTSI consultation. Each outcome was compared between the prePBLD group (AY 2008 [n=43] and AY 2009 [n=42]) and the postPBLD group (AY 2010 [n=43] and AY 2011 [n=50]).

Main Results

The number of residents who consulted the CTSI as new investigators increased from 4 of 85 residents (4.7%) in the prePBLD group to 13 of 93 residents (14.0%) in the postPBLD group (P = 0.042). The number of new research projects for which the residents consulted CTSI increased from 10 to 20 (100% increase).

Conclusion

A PBLD format for research education of anesthesiology residents is effective.

Keywords: Anesthesiology residents, Problem-based learning discussion, Research education, Residency

1. Introduction

Research is essential for future advancement of anesthesiology [1,2]. Residents, as the future leaders, should have basic knowledge of the conduct of an original clinical research project and should be familiar with the resources available to initiate a research project [3]. Resident scholarly activity is included in the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Graduate Medical Education in Anesthesiology. The requirements state, “The curriculum must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care (IV.B.1.). Residents should participate in scholarly activity (IV.B.2.). The sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities (IV.B.3.)”¹ However, educational methods to achieve these goals have not previously been universally established as a part of the anesthesiology curriculum.

A Problem-Based Learning Discussion (PBLD) format for research education was developed in a university-based residency program in academic year (AY) 2010. The PBLD is an active-learning pedagogical format with a problem-based, student-centered, small-group approach using simulated scenarios as a means of avoiding the educational assumptions made by the more conventional teacher-centered lecture-discussion format. The method has been used worldwide and in a variety of disciplines, including anesthesiology [4]; however, the experience with the PBLD in teaching research fundamentals is very limited [5].

The content of the research PBLD is presented. Its effect on residents’ participation in research activities was evaluated by assessing utilization of the research support system introduced during the PBLD.

2. Materials and methods

The University of Pittsburgh School of Medicine Institutional Review Board (IRB) designated this project as exempt (IRB number PRO10120051). To evaluate the effect of the research PBLD, anesthesiology residents in an academic institution who attended the PBLD session in AY 2010 and in AY 2011 (postPBLD group) were compared with a historical cohort of residents who did not attend research PBLD sessions in AY 2008 and in AY 2009 (prePBLD group).

2.1. Resident class

A total of 93 residents made up the post-PBLD group. In AY 2010, 43 residents attended the research PBLD (13 postgraduate year 4 [PGY4], 14 PGY3, and 16 PGY2), and in AY 2011, 50 residents attended (14 PGY4, 16 PGY3, and 20 PGY2). The total prePBLD group consisted of 85 residents (43 residents [PGY2–4] in AY 2008 and 42 residents [PGY2–4] in AY 2009).

2.2. Creation of research PBLD

2.2.1. PrePBLD resident survey

An internal needs-assessment survey was conducted in November 2009 (AY 2010) using an internet-based survey. The request was sent to all residents (PGY2–4; n = 43) as well as PGY1 (n = 9) via e-mail two months before the PBLD. Degree of perceived barriers in each aspect of conducting research was queried [Appendix 1]. The survey also queried residents about whether they planned to participate in research during their residency. The same survey was administered in AY 2011, the results of which were used to design the research PBLD to address the barriers for this group.

2.2.2. Clinical and Translational Science Institute (CTSI)

The CTSI, funded by the National Institutes of Health (NIH) in 2006, serves the specific purpose of reducing barriers to research and assisting investigators at our institution as they navigate increasingly complex research systems. CTSI’s mission is to improve the efficiency with which biomedical advances translate to improvements in the health of the community. CTSI is transforming the process of clinical and translational research by providing research resources, thus enabling scientists to generate new biomedical knowledge by offering the support required to conduct visionary, relevant, clinical, and translational research and to move actionable research findings into practice and prevention settings. CTSI supports researchers in all aspects of research, including assistance with research planning, regulatory support (ie, IRB submission), data and regulatory assistance with electronic medical record research, statistical support, recruitment assistance, and pilot funding.

2.2.3. Structure of scenario for research PBLD

The research case scenario in the research PBLD was designed based on the topic of interest most frequently suggested by residents in the prePBLD survey. The PBLD scenario was constructed in such a way that an anesthesiology resident would simulate serving as the primary investigator of a prospective, randomized, clinical study. In the scenario, the anesthesiology resident would encounter a clinical question. The residents were then walked through the steps of performing a literature search, formulating a research question, identifying research resources available in the university setting, finding a research mentor/co-investigators, preparing a department seed grant (detailing the hypothesis to be tested, specific aims, study design, outcome measures, statistical planning, co-investigators, and beginning the IRB proposal), recruiting study participants, performing an interim analysis, and presenting/publishing the study. Various pitfalls, including authorship conflict, were also discussed. A model discussion was written by the faculty members as a reference. The CTSI Research Facilitators were involved in planning, creation, and delivery of the PBLD.

2.3. Delivery of the research PBLD

The research PBLD was delivered in November 2009 (AY 2010) and September 2010 (AY 2011) as part of the residency program’s annual PBLD series. Ninety-minute PBLDs on various topics are provided annually by faculty members; attendance by residents (PGY2, PGY3, and PGY4 classes) is mandatory. Given the size of the resident classes, each is divided into two groups alphabetically by surname and each group (21 – 25 residents per group) receives the same PBLD one week apart. The PBLD scenario was distributed to participants one week earlier so that they could prepare for the discussion.

On the day of the PBLD, a roundtable discussion was led by three facilitators. Using the research study scenario, specific questions were debated in an interactive discussion with participating residents. The authors prepared summary slides to facilitate understanding of research concepts.

2.4. Outcome measures and analysis

The effectiveness of the research PBLD was measured by the changes after participation in this learning session in the number of 1) residents who made CTSI consultation solicitations as a new investigator (ie, first-time consultation to this research institution), and 2) new projects proposed by residents who consulted CTSI. The above data were compared between the prePBLD period and the postPBLD period. In the former comparison, two-tailed Fisher’s Exact test was performed. In the latter, the percentage change was calculated. A P-value < 0.05 was considered statistically significant. Statistical analysis was performed using Graph-Pad Prism 5 (GraphPad Software, Inc., La Jolla, CA, USA).

3. Results

3.1. PrePBLD resident survey

The total number of survey respondents in AY 2010 was 35 (67.3%) among the 52 total residents and interns (PGY1 [6 of 9], PGY2 [10 of 16], PGY3 [8 of 14], and PGY4 [8 of 13]). Three respondents failed to identify their residency year.

Grants, regulatory issues, and statistics/data analysis were identified as the three biggest perceived research barriers [Table 1]. For research interest, 74% (26 of 35) stated that they planned to perform research, while the remaining 26% stated that they had no plan to do research.

Table 1.

Results of survey administered to residents before development of the research problem-based learning discussion (n = 35): “Which aspects of research represent a barrier to you and to what extent?”

	No barrier		Moderate barrier		Complete barrier
	1	2	3	4	5
a) Regulatory^a	2.9% (1)	8.6% (3)	28.6% (10)	48.6% (17) ^*	11.4% (4)
b) Specific aims/hypothesis	11.4% (4)	34.3% (12)	45.7% (16) ^*	8.6% (3)	0.0% (0)
c) Study design	8.6% (3)	25.7% (9)	42.9% (15) ^*	22.9% (8)	0.0% (0)
d) Grants	5.7% (2)	2.9% (1)	28.6% (10)	45.7% (16) ^*	17.1% (6)
e) Statistics/data analysis	5.7% (2)	14.3% (5)	14.3% (5)	54.3% (19) ^*	11.4% (4)
f) Study conduction/implementation^b	5.7% (2)	22.9% (8)	42.9% (15) ^*	22.9% (8)	5.7% (2)
g) Ms. preparation/publication	11.4% (4)	31.4% (11)	40.0% (14) ^*	14.3% (5)	2.9% (1)

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Data are percentages of total respondents (no. of respondents).

Ms.=manuscript.

Institutional Review Board approval, Fiscal Review, Clinical Trials Office, the Food and Drug Administration, or independent data safety monitoring.

Consenting procedure, data collection, organization, security.

Mode of all responses to each question.

3.2. Research PBLD scenario

Based on the prePBLD survey results, the scenario’s focus was designed to address the various barriers the residents perceived in participating in research activity, especially the three biggest ones identified: grant writing, regulatory issues (especially application of the institutional review board), and statistics/data analysis. Given the time constraint of 90 minutes of the PBLD, statistical and data analysis support systems available through the CTSI mechanism were introduced.

3.3. Outcome measures

The number of residents who consulted CTSI as new investigators increased from 4 of 85 residents in the prePBLD period (AY 2008 and AY 2009) to 13 of 93 residents in the postPBLD period (AY 2010 and AY 2011). This increase reached statistical significance (P = 0.042).

The number of new research projects for which residents consulted CTSI increased from 10 in the prePBLD period to 20 in the postPBLD period, or a 100% increase.

4. Discussion

After implementation of the PBLD method to educate anesthesiology residents about clinical research in an academic department, the number of residents who participated in research projects and utilized available research resources increased.

The PBLD format, which was first reported and further developed by Howard S. Barrows and colleagues [6,7], makes use of real-life scenarios to stimulate residents’ previous knowledge and to provide a meaningful context that is also related to the student’s future professional work, enabling active peer teaching-learning in an open communication style [8–11]. This format was selected because: 1) a simulated scenario would help engage each resident in research processes and facilitate discussion; 2) the interactive discussion among residents with varying levels of research experience would facilitate peer-to-peer learning; and 3) residents would be introduced to research resources available in their institution for each stage of research activity. The residents actually participated in the creation of the research PBLD by responding to the prePBLD survey, which helped faculty members to identify residents’ perceived research barriers.

Identification of resources available to investigators in each institution is important. CTSI has become a centerpiece of the support structure. The CTSI has been supported since 2006 by the Clinical and Translational Science Awards (CTSA) program at the National Center for Advancing Translational Sciences (NCATS). Institutional CTSA awards provide academic homes for translational sciences and support research resources needed by local and national research communities to improve the quality and efficiency of all phases of translational research, and to provide training of clinical and translational scientists and the development of all disciplines needed for a robust workforce for translational research. Currently, about 60 medical research institutions in 30 states and the District of Columbia are active members of the CTSA Consortium². Despite the excellent track record of contribution in research support, the anesthesiology residents underutilized CTSI despite several attempts to publicize the presence and function of the CTSI. After the inception of CTSI in 2006, its role has been advertised via posters throughout the university campus that included website information. In August 2008, the Department of Anesthesiology held a one and a half day research symposium for residents, during a lecture on CTSI, which was given. The fact that there was a significant increase in the number of CTSI users after the research PBLD suggests the effectiveness of this active educational intervention. The research PBLD has helped improve awareness of the available infrastructure for anesthesiology residents. In addition to the CTSA consortium, there are a number of local research resources available to anesthesiology trainees, including senior research faculty members and local IRB offices.

There are several limitations to this study. First, other educational initiatives were implemented during the study period. These included the appointment of a director of the resident research rotation as of AY 2006, as well as the awarding of a NIH T32 institutional postdoctoral training grant as of AY 2008. Therefore, the increase in number of residents who participated in research projects in this study period [12] might not be attributed solely to the research PBLD. However, the study endpoints (number of new residents who consulted CTSI and new research projects for which residents consulted the CTSI) were chosen as they were directly related to the research PBLD. Second, this study was unable to access the long-term effects of the research PBLD on residency graduates’ academic productivity simply because of the limited follow-up duration. This effect is certainly of interest and will be investigated in the future. Third, the PBLD scenario would need to be modified to parallel research resources available in each institution. Furthermore, the PBLD format is a resource-intensive pedagogical method [13], and the cost of its delivery is often cited as a significant issue [14]. The importance of the tutor as an effective facilitator has also been stressed [15]. However, since use of the PBLD method is not new [4], applying this pedagogical method in teaching research fundamentals in each institution is worthwhile.

In conclusion, application of a PBLD format to teach the research process to anesthesiology residents is effective.

Acknowledgments

The authors acknowledge the help of the following individuals in establishing the research PBLD: Nicole E. Scouras, MD, MPH (currently at Duke Raleigh Hospital; University of Pittsburgh School of Medicine Anesthesiology Residency, Class of 2010) and James W. Ibinson, MD, PhD (Assistant Professor, Department of Anesthesiology, University of Pittsburgh School of Medicine Anesthesiology Residency, Class of 2010). The authors thank Christine M. Heiner, BA (Scientific Writer, Department of Anesthesiology/Department of Surgery, University of Pittsburgh School of Medicine) for her editorial assistance with this manuscript.

Appendix 1. Survey administered to residents before development of the research problem-based learning discussion

1. Which aspects of research represent a barrier to you and to what extent?

a) Regulatory (IRB approval, Fiscal Review, Clinical Trials Office, FDA, independent data safety monitoring)