New education method or tool
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The Scholarly Brainstorming Project: An Initiative to Increase Scholarly Productivity in a Large Internal Medicine Program

Gabriel Aisenberg[1], Gus W. Krucke[1]

Institution: 1. University of Texas, John P. and Kathrine G. McGovern School of Medicine
Corresponding Author: Dr Gabriel Aisenberg ([email protected])
Categories: Scholarship/Publishing
Published Date: 15/10/2020

Abstract

Background: In the academic year 2014-2015, the Internal Medicine residency program at the University of Texas in Houston had 130 residents. Of those, only 13 of them published papers in peer-reviewed journals and 5 residents presented posters at local, state, or national meetings. Moreover, that year, in the Accreditation Council for Graduate Medical Education annual survey results, only 44% of our residents acknowledged the existence of scholarly opportunities.

Objective: To increase scholarly productivity and consequently, the perception of scholarly opportunities in our Internal Medicine residency program.

Methods: The Scholarly Brainstorming Project (SBP) consists of monthly meetings at the end of each ward block. The attendees are to brainstorm for ideas with potential for publication as case reports, retrospective or prospective research, literature reviews and/or quality improvement projects. Faculty members with research experience are present to facilitate the discussions. These ideas are collectively discussed, first in small groups and then as a whole; mentors are assigned, and expectations timetables established.

Results: Compared to 2015, the number of residents involved (7% to 220%), their scholarly productivity (300% to 700%), and the perception of scholarly opportunities (38% to 211%) grew considerably, compared to baseline.

Conclusions: Unlike other interventions proposed to increase scholarly productivity, SBP addresses the critical step of observing the daily reality of the physicians’ duties, identifying aspects of patient care that could potentially be converted into a scholarly product.

Keywords: scholarly; residency; internal medicine; research

Introduction

The progressive change in the role of academic physicians, from scientists to bedside educators, removes from the latter the knowledge and necessary training to instruct the new generations on how to include a scholarly approach in their daily medical activities (Marks, 2007; Bunton and Mallon, 2007).   

The Accreditation Council for Graduate Medical Education (ACGME) requires residents to generate scholarly publications as a measure of productivity and excellence; the experience gained doing so is valuable for a successful research experience during fellowships, where such activity is also expected (ACGME.org, 2018). While multiple methods have been developed with the intention to increase scholarly productivity in residency programs of varied specialties, none of the ones reported centres the efforts on a simple reflection of what the ordinary medical activities of caring for patients on the wards might offer. A publication encourages academic faculty rather than residents to transform the busy clinical work into scholarly activities (Schrager, Pollart and Sadowski, 2019). Recent patient encounters, diagnostic and therapeutic dilemmas encountered in clinical practice for which little or no evidence-based literature exists represent the pearls of opportunities to publish. Quality improvement projects, case reports, musings on ethics in medicine amongst a host of other ideas are at our fingertips.

In the academic year 2014-2015, the Internal Medicine residency program at the University of Texas in Houston had 130 residents. Of those, only 13 of them published papers in peer-reviewed journals and 5 residents presented posters at local, state, or national meetings. Moreover, that year, in the ACGME annual survey results, only 44% of our residents acknowledged the existence of scholarly opportunities. These numbers had been progressively declining for 5 years and motivated the present intervention. To improve this disturbing trend, we devised the Scholarly Brainstorming Project (SBP).

Methods

The University of Texas McGovern School of Medicine Internal Medicine Residency program trains 130-140 on a 3-year journey of work and learning in four different hospitals, all of them unique. The SBP consists of monthly meetings at the end of each ward block in one of the four hospitals (Lyndon B. Johnson Hospital in Houston, Texas). Residents and students meet in groups to discuss their experiences for that month. The instructions delivered at the beginning of the meetings lead the attendees to brainstorm for ideas with potential for publication as case reports, case series, retrospective or prospective research, literature reviews, and/or quality improvement projects. Faculty members with research experience are present to facilitate the discussions, helping to refine the study question, to select the adequate outcomes, and to identify the proper research study design, when appropriate (Beckman and Cook, 2007). These ideas are collectively discussed, first in small groups and then as a whole; mentors are assigned, and expectations timetables established. Follow up emails, phone calls, and meetings help to facilitate the process following the initial conference. The projects birthed from SBP are tracked in a database in order to assure successful conferences or publications, or perhaps even abandoning a proposal.

The overall goals of the project are to improve the perception of the scholarly productivity in our division and increase the scholarly visibility in the medical community through the publication of more high-quality peer-reviewed articles, and/or presentations in local, state, national, and international meetings. Ultimately, stronger fellowship applications, faculty curricula, and the attraction of stronger residency candidates are secondary goals of the intervention.

We tabulated our scholarly productivity (number of residents involved, number of publications, and number of poster presentations) before and after the implementation of the SBP, and until June 2019 (last dataset available). We also compared the perception of scholarly opportunities before and after the intervention as per the results of related questions in the ACGME annual resident survey.

Results

Figure 1 shows the number of scholarly products (peer-reviewed publications, posters presented in conferences, and books or book chapters) and the perception of scholarly opportunities by our residents according to the ACGME survey since the SBP started. Table 1 outlines details regarding the number of involved residents and the type and number of scholarly products. Compared to our baseline in 2015, there is an evident improvement in the number of residents involved, as well as their scholarly productivity that correlates well with the overall perception of scholarly opportunities disclosed by the group.

Figure 1. Progress of perception of scholarly opportunities (in %) and all scholarly products (in numbers)

 

Table 1. Number of residents involved in the generation of every scholarly product from 2014-2015 to 2018-2019

 

Residents involved

Peer-reviewed publications

Residents involved

Presentations in meetings

Residents involved

Book Chapters

2014-2015

13

41

5

9

0

0

2015-2016

14

31

53

128

2

2

2016-2017

29

91

124

248

9

9

2017-2018

29

77

56

147

2

2

2018-2019

21

57

99

223

3

6

 

Scholarly productivity increased considerably after the introduction of this project.

The ACGME requires residents to participate in the production of scholarly endeavours; our experience is that such success is extremely valuable, especially as a platform to learn how to initiate scientifically excellent productivity during fellowships training (ACGME.org, 2018). One study, however, demonstrated a poor correlation between the number of publications that a trainee spawns during residency and fellowship (Prasad et al., 2014). The ACGME places greater value on the acquisition of tools learned during residency rather than on the number of scholarly products at that training level (Philibert et al., 2013). We believe our approach opens doors to early collaboration, mentoring by senior researchers, and increased productivity. 

It is our opinion that projects which did not originate in the SBP environment seemed to contribute to the spirit and creation of enthusiasm for opportunities to participate in the scholarly works which reflects the best we have to offer; a deeper and more meaningful connection with the science of medicine; enhancing the autonomous motivation of the learners (Kusurkar, 2019). As the project unfolded, we observed that the residents reached out to mentors more often, and both residents and students seemed to have passed on this enthusiastic approach to their younger colleagues who entered the program or shared in learning on the wards, in the clinics, and in the ICU. With four platforms available to our learners, the project appears ripe for such opportunities in a variety of patient care environments. It is our hope that sharing our experience in this area will create a wave of contagious enthusiasm to contribute to evidence-based medicine.

A host of interventions have been proposed to increase scholarly productivity: academic coaches or mentors [Dennis et al., 2019; McKinney et al., 2019); formal research curricula designed for trainees and faculty (Miner et al., 2019; Fenton et al., 2015; Neale et al., 2003; Carek et al., 2011; Coleridge, Smith-Barbaro and Knisley, 2004); and even reward or point-counting systems for the trainees involved in research (Emerick et al., 2013; Onishi et al., 2016). None of these interventions address the critical step of observing the daily reality of the physicians’ duties, identifying aspects of patient care that could potentially be converted into a scholarly product. Because of our efforts, there is an emphasis on the successful production of scientifically excellent, scholarly activity rather than the concern about how the product will be received. In this setting, markers of individual academic output such as number of papers in a specific period, number of citations of those papers, combinations of these variables, or authorship order represented less relevant outcomes in our project (Hirsch, 2005; Khan et al., 2019).

Conclusion

The SBP promoted reflection, led to the emergence of ideas worthy of scientifically excellent, scholarly endeavours, and increased enthusiasm amongst residents for vistas in scholarly pursuits they had not previously considered in our Internal Medicine residency program.  

Take Home Messages

  • The United States Accreditation Council for Graduate Medical Education (ACGME) requires residents to generate scholarly publications.
  • The Scholarly Brainstorming Project (SBP) consists of monthly meetings at the end of each ward block aimed to brainstorm for ideas with potential for publication.
  • Compared to a baseline in 2015, the number of residents involved, their scholarly productivity, and the perception of scholarly opportunities grew considerably after SBP started.
  • Unlike other interventions proposed to increase scholarly productivity, SBP addresses the critical step of observing the daily reality of the physicians’ duties, identifying aspects of patient care that could potentially be converted into a scholarly product.

Notes On Contributors

Gabriel M. Aisenberg, MD, FACP, is an Associate Program Director of Internal Medicine in the University of Texas in Houston, Texas, USA.

Gus W. Krucke, MD, FACP, is an Associate Professor of Internal Medicine in the University of Texas in Houston, Texas, USA.

Acknowledgements

Figure 1. Source: the authors.

Bibliography/References

ACGME.org (2018) ACGME document on residents’ scholarly requirements. Available at: https://www.acgme.org/Portals/0/PDFs/Specialty-specific%20Requirement%20Topics/DIO-Scholarly_Activity_Resident-Fellow.pdf?ver=2018-06-29-082335-797 (Accessed: 19 May 2020).

Beckman, T. J. and Cook, D. A. (2007) ‘Developing scholarly projects in education: A primer for medical teachers’, Medical Teacher. 29(2-3), pp.210-218. https://doi.org/10.1080/01421590701291469

Bunton, S. A. and Mallon, W. T. (2007) ‘The continued evolution of faculty appointment and tenure policies at U.S. medical schools’, Academic Medicine, 82(3), pp.281-289. https://doi.org/10.1097/acm.0b013e3180307e87

Carek, P., Dickerson, L. M., Diaz, V. A., Steyer, T. E. (2011) ‘Addressing the scholarly activity requirements for residents: one program’s solution’, Journal of Graduate Medical Education, 3(3), pp.379-382. https://doi.org/10.4300/jgme-d-10-00201.1

Coleridge, S. T., Smith-Barbaro, P. and Knisley, C. (2004) ‘A practical method for increasing scholarly activity in an academic family medicine department’, Teaching and Learning in Medicine, 16(2), pp.181-185. https://doi.org/10.1207/s15328015tlm1602_11

Dennis, M., Batalini, F., Demers, L. and Upadhyay, A. (2019) ‘Overcoming barriers to resident scholarly productivity and research at a large academic institution’, MedEdPublish. https://doi.org/10.15694/mep.2019.000213.1

Emerick, T., Metro, D., Patel, R. and Sakai, T. (2013) ‘Scholarly activity points: a new tool to evaluate resident scholarly productivity’, British Journal of Anaesthesia, 111(3), pp.468-476. https://doi.org/10.1093/bja/aet106

Fenton, K. E., Kim, J., Abramson, E., Waggoner-Fountain, L.A., et al. (2015) ‘Mentoring resident scholarly activity: a tool kit and guide for program directors, research directors and faculty mentors’, MedEdPortal. https://doi.org/10.15766/mep_2374-8265.10103 

Hirsch, J. E. (2005) ‘An index to quantify an individual’s scientific research output’, Proceedings of the National Academy of Sciences of the United States of America, 102(46), pp.16569-16572. https://doi.org/10.1073/pnas.0507655102

Khan, N. R., Saad, H., Oravec, C. S., Norrdahl, S. P., et al. (2019) ‘An analysis of publication productivity during residency for 1506 neurosurgical residents and 117 residency departments in North America’, Neurosurgery, 84(4), pp.857-867. https://doi.org/10.1093/neuros/nyy217

Kusurkar, R. A. (2019) ‘Enhancing autonomous motivation of students should be an integral part of the educational philosophy of a medical school’, Medical Teacher, 41(8), pp.969. https://doi.org/10.1080/0142159x.2018.1554894

Marks, A. R. (2007) ‘Physician-scientist, heal thyself…’, The Journal of Clinical Investigation, 117(1), pp.2. https://doi.org/10.1172/jci31031

McKinney, C. M., Mookherjee, S., Fihn, S. D. and Gallagher, T. H. (2019) ‘An academic research coach: an innovative approach to increasing scholarly productivity in medicine’, Journal of Hospital Medicine, 14(8), pp.457-461. https://doi.org/10.12788/jhm.3194

Miner, T. J., Richardson, P., Cioffi, W. G. and Harrington, D. T. (2019) ‘The resident outcome project: increase academic productivity associated with a formal clinical research curriculum’, Journal of Surgical Education, 76(6), pp.e161-e166. https://doi.org/10.1016/j.jsurg.2019.07.016

Neale, A. V., Schwartz, K. L., Schenk, M. and Roth, L. M. (2003) ‘Scholarly development of clinician faculty using evidence-based medicine as an organizing theme’, Medical Teacher, 25(4), pp.442-447. https://doi.org/10.1080/0142159031000137481

Onishi, K., Perret Karimi, D., Hata, J., Newcomb, R., et al. (2016) ‘The Badges Program: a self-directed learning guide for residents for conducting research and a successful peer-reviewed publication’, MedEdPortal, Available at: https://doi.org/10.15766/mep_2374-8265.10443

Philibert, I., Lieh-Lai, M., Miller, R., Potts 3rd, J. R., et al. (2013) ‘Scholarly activity in the Next Accreditation System: moving from structure and process to outcomes’ Journal of Graduate Medical Education, 5(4), pp.714-717. https://doi.org/10.4300/JGME-05-04-43

Prasad, V., Rho, J., Selvaraj, S., Cheung, M., et al. (2014) ‘Can a resident’s publication record predict fellowship publications?’, PLOS One, 9(3), pp.e90140. https://doi.org/10.1371/journal.pone.0090140

Schrager, S., Pollart, S. and Sadowski, E. (2019) ‘Transforming your daily work into scholarship: Tips for a busy clinical-scholar’, MedEdPublish. https://doi.org/10.15694/mep.2019.000210.1

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This research was considered by the Committee for the Protection of Human Subjects (IRB) at The University of Texas Health Science Center at Houston on July 1, 2020, and deemed exempt because this is research involving the use of existing data that cannot be identified with individual subjects. The research was conducted in accordance with the Declaration of Helsinki.

External Funding

This article has not had any External Funding

Reviews

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Subha Ramani - (24/10/2020) Panel Member Icon
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This article focuses on an issue likely faced at many postgraduate education programs. Junior doctors/residents, who are busy at the frontlines of clinical care, may not have the time or mindset to focus on scholarship- unless they have had prior research experience and / or have already decided on a future research career. In the latter case, they need to apply to competitive fellowship programs and must engage in research during residency. Creating an environment to discuss how clinical cases and quality of care can be converted into scholarship is an innovative approach. The impact this program has had on scholarly output and perceptions about scholarly opportunities is also very positive. I am not sure that they can bring in Kusurkar's work on motivation with these preliminary results especially if they have not explored whether this initiative enhanced motivation of residents.

I do have some constructive comments:
1. Introduction- This provides readers with a reasonable road map of the curriculum and study. The order of paragraphs could be more streamlined- what is the problem (lack of scholarship among residents), why is it important (ACGME mandates and preparation for future academic careers or training), the gap (creating opportunities for scholarship from daily clinical work) and curricular aims
2. Methods- the authors have described their program with clarity
3. Results- the trend towards increased scholarship is described. It would have been nice to get some narrative comments from residents. I am not clear about reporting of percentages- 200% etc
4. Although the discussion section has not been labelled, I am guessing that the paragraph that starts with "The ACGME" is the beginning of the discussion section. I am really having a challenging time going back and forth between the 3 paragraphs to mine the most important messages. The first paragraph should summarize key findings, the next 2 should select 2 important points that arise from the study, expand on them and relate them to other literature as applicable. Then we need some limitations and conclusions. I am not clearly seeing each paragraph highlighting a message clearly. I see them as looking at clinical activities as opportunities for scholarship, engaging with faculty with research experience and mentoring.

The most important comment I have is that attention should be paid to clarity, simplicity in structuring sentences and minimization of grammatical errors. Some sentences are long and complex.
e.g. While multiple methods have been developed with the intention to increase scholarly productivity in residency programs of varied specialties, none of the ones reported centres the efforts on a simple reflection of what the ordinary medical activities of caring for patients on the wards might offer.

What do the authors mean by the initial sentence:
"The progressive change in the role of academic physicians, from scientists to bedside educators, removes from the latter the knowledge and necessary training to instruct the new generations on how to include a scholarly approach in their daily medical activities."
Clinical supervision needs bedside educators, but I don't follow the meaning in the phrase- the progressive change....

rather than 'improving disturbing trends', it might be better to state 'reverse disturbing trends'.

The authors can choose past or present tense in writing the paper, but be consistent in its use.

Bottomline, this is an innovative program to enhance scholarship among residents and those engaged in Postgraduate medical education / residency education will find it useful.
Karen Szauter - (15/10/2020)
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This article describes a project to enhance scholarly work at a busy internal medicine residency in the US. The project takes advantage of real-life workplace questions to stimulate scholarship, builds resident-faculty relationships, and provides opportunities for mentorship. The authors have shown a notable increase in scholarly productivity with this project and have sustained an increased level of resident scholarship over time. As described, this process is easily adaptable at other institutions and has benefits beyond what is described. From the table it appears that the majority of residents became involved in dissemination of scholarly materials which is impressive. Ongoing efforts to engage trainees in activities which stimulate curiosity and scholarly work are important to discuss; the project is described well in the paper and contributes to ideas of how to assist residents in contributing to knowledge in our profession.