JAOA • Vol 104 • No 4 • April 2004 • 177-179
A Divisional Approach to Enhancing Research Among Osteopathic Family Practice Residents
Peggy Smith-Barbaro, PhD;
Kimberly G. Fulda, MPH;
Samuel T. Coleridge, DO
Address correspondence to Kimberly G. Fulda, MPH, University of North Texas
Health Science Center—Texas College of Osteopathic Medicine, 3500 Camp
Bowie Blvd, Fort Worth, TX 76107-2699. E-mail:
kfulda{at}hsc.unt.edu
There is an increasing demand to expose osteopathic family practice
residents to research. Within the Department of Family Medicine at the
University of North Texas Health Science Center at Fort Worth—Texas
College of Osteopathic Medicine, the Division of Education and Research (DEAR)
was developed in 1999. The primary focus of DEAR is to provide the necessary
resources and knowledge for faculty members and residents to conduct research
and accomplish scholarly activities. Guidelines are implemented to ensure the
timeliness, efficiency, and completion of each resident's paper.
The efficacy of DEAR's policies is evaluated annually through surveying the
residents, tracking paper submissions to the resident director, and tracking
publications and presentations. The expectation of DEAR's resident research
component is full completion of a resident paper suitable for publication in a
peer-reviewed journal before graduation. Initial evaluation suggests positive
strides toward reaching this goal. Future successes will be determined by
monitoring the next few years.
Exposing residents to family practice research provides essential skills
for complete medical career maturation. For this reason, the American College
of Osteopathic Family Physicians (ACOFP) and the American Academy of Family
Physicians recommend curricula in research
education.1,2
Accordingly, family practice residency programs are increasingly requiring a
research
component.3
Helping residents overcome obstacles to complete projects should be a key
focus of programs requiring
research.4 A survey
of family practice residents in Ohio found that only 22% of residents believed
family practice physicians should conduct research and that one third of
third-year residents believed they had adequate training to conduct
research.5 Ryan et
al6 propose that a
required research component is "unjust" if residents do not have
access to relevant training and guidance. The availability of educational and
physical resources, such as computers, space, and seminars, is progressively
addressed by family medicine departments with successful research
programs.7 Within
the Department of Family Medicine at the University of North Texas Health
Science Center at Fort Worth—Texas College of Osteopathic Medicine
(UNTHSC), the Division of Education and Research (DEAR) was developed in 1999
and included a program to assist family practice residents in completing
research papers.
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Division of Education and Research—A Model System
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The primary focus of DEAR is to create and maintain a research environment
for faculty, residents, and students. A DEAR research associate helps
residents select a topic and type of research paper/project, pick an
appropriate journal for submission, acquire permission from the UNTHSC
Institutional Review Board, develop databases, and edit rough drafts. Four
other primary members of DEAR include the director, director of research and
funding, medical informatics computer user analyst, and editorial assistant.
The primary obligations of DEAR's director are to find funding for independent
resident projects, oversee the research program, and remove barriers likely to
inhibit the research process. The director of grants and funding assists with
protocol methodology, biostatistics, database development, and epidemiology.
Residents learn to conduct literature searches, manage databases, and use the
clinical digital library from the medical informatics computer user analyst.
The editorial assistant maintains departmental research records, assists with
logistic aspects of submitting papers, and procures the availability of
resources.
The Department of Family Medicine chair and DEAR implemented steps to
ensure support and guidance and to monitor resident progress. These steps
include collaborative meetings between the Department of Family Medicine
chair, director of DEAR, and family practice residency director. The research
associate sustains contact with residents through phone conversations,
one-on-one meetings, and monthly meetings. Within the first 3 months of their
residencies, residents attend a presentation on how to write a research paper
and options available for projects. Residents are given an extensive
Handbook on Research containing a variety of articles and
references.
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ACOFP and Departmental Policies
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Since 1995, the ACOFP requires family practice residents to complete a
residency rotation to be eligible for board certification. The residency must
"provide opportunities for residents to participate in research or other
scholarly
activities."1
This requirement may be met by having residents participate in departmental
research projects; participate in institutional research projects involving
the Department of Family Medicine; participate in area-wide or multicentered
projects involving the Department of Family Medicine; write an original paper
on a health care topic; present at a state, regional, or national meeting; or
author a grant.1
Additionally, residents must complete their papers/research projects within 6
years of entering their residency
(Table).
To encourage resident compliance with ACOFP requirements, the Department of
Family Medicine at the UNTHSC initiated a new policy beginning with the 2003
graduating class stipulating that board examination expenses will only be
reimbursed for residents submitting a paper by the end of their third year.
Furthermore, the program completion certificate is withheld until a final
paper is submitted. A timeline for accomplishing this requirement is clearly
presented to residents during their first year of residency. Due dates for
each research component are given throughout the residency, and each
resident's progress is monitored individually.
The division phased in a new timeline over three entering classes from 1999
to 2001. Currently, residents select a topic by February of their first year,
complete a literature review by June of their first year, submit a draft paper
to DEAR by November of their second year, submit a final paper to the
residency program director by April of their second year, submit the revised
department-approved paper to the ACOFP by July of their third year, and submit
their paper to a journal by November of their third year
(Table). Completing
the paper in the first half of the third year allows residents to focus on
other issues before graduation, such as securing employment. Additionally, it
allows 7 months for revisions and/or resubmissions to journals. The department
takes pride in graduating residents with research experience and
marketability.
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Project Types
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Family medicine residents at UNTHSC choose from various types of research
projects, including research papers from original research, literature
reviews, case reports, case reviews, editorials, and letters to the editor.
Residents are encouraged to choose an interesting and relatively narrow topic.
A letter to the editor must be accepted for publication in a peer-reviewed
journal for research credit. For residency certification, a research paper
suitable for publication in a peer-reviewed journal must be submitted to the
ACOFP. Each paper must be approved by the residency director. The Division of
Education and Research encourages residents to select an appropriate journal
before the writing process begins. The
Table shows an 11-step
process for completing resident research papers. During or before 2002, the
type of papers completed by residents graduating have been 50% case reports,
35% literature reviews, and 15% research projects, such as surveys,
retrospective chart reviews, and case-control studies. Residents may also work
on a research project with a faculty member and submit a literature review on
the topic if the project will not be completed by graduation. The literature
review will be reformatted to serve as the introduction to the final paper
submitted for publication.
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Evaluation/Next Steps
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After 1 year of exposure to DEAR, only 3 (37.5%) of the 8 graduating
residents turned in a final draft of their paper by the end of their third
year. At 2 years postproject initiation (2001), 7 (58.3%) of 12 graduating
residents completed papers by the end of their third year. Three years
postproject initiation (2002), 8 (72.7%) of 11 residents submitted a paper by
graduation. These results suggest that DEAR's residency component is
successfully promoting timely completion of resident papers.
Several steps will be taken to evaluate DEAR's effectiveness. A survey of
residents' perceived barriers was implemented in 2001. This survey will be
given annually, and responses will be analyzed to determine DEAR's
effectiveness in alleviating obstacles. Additionally, timely submissions and
the annual number of publications and presentations will be recorded. With new
timelines strictly encouraged and enforced, these outcome measures should
increase with each graduating class.
It is further recognized that as an increasing percentage of residents
choose research projects over health care–related papers and the level
of sophistication for resident research increases, the timelines will need to
be adjusted. This will allow more time for developing the research proposal,
collecting data, and analyzing data. These adjustments may be accepted, with
careful monitoring, to ensure research and scholarly activity are a priority
and the research requirement is completed by graduation.
From the Division of Education and Research, Department of Family
Medicine, University of North Texas Health Science Center at Fort
Worth—Texas College of Osteopathic Medicine.
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References
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1. American Osteopathic Association, American College of Osteopathic
Family Physicians. Basic standards for residency training in osteopathic
family practice and manipulative treatment. Available at:
http://www.aoa-net.org/Accreditation/postdoctoral/fpwrkbk3.pdf.
2. American Academy of Family Physicians. Recommended core educational
guidelines for family practice residents: Research and scholarly activity.
Am Fam Physician. 1992;46:1564
-1566.[Medline]
3. Coleridge ST. A proposal to modify research and scholarly
activities during osteopathic residency training. J Am Osteopath
Assoc. 1991;91:891
-894.[Medline]
4. Gill S, Levin A, Djurdjev O, Yoshida EM. Obstacles to residents'
conducting research and predictors of publication. Acad
Med. 2001;76:477
.[Medline]
5. Costa AJ, Gerson LW. Residents surveyed about the value of
research. Fam Med. 1998;30:618
.[Medline]
6. Ryan JG, Bonanno RJ, Dunn G, Fahrenwald R, Kirsch S. Required
research a disservice? Fam Med. 1997;29:610
.[Medline]
7. DeHaven MJ, Wilson GR, O'Connor-Kettlestrings P. Creating a
research culture: What we can learn from residencies that are successful in
research. Fam Med. 1998;30:501
-507.[Medline]
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