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NOTES FROM THE ASSOCIATION OF MEDICALSCHOOL PEDIATRIC DEPARTMENT CHAIRS, INC.

A Pediatric Residency Research Curriculum

ELLEN WOOD, MD, MSC, FRCPC, AND JONATHAN B. KRONICK, MD, PHD, FRCPC, FAAP

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ntil relatively recently, the overriding purpose ofresidency training in any specialty or subspecialtywas to train medical experts to provide competent

atient care. In 1996, the Royal College of Physicians andurgeons of Canada (RCPSC) defined 7 competencies forpecialists (the CanMEDS framework): medical expert, com-unicator, collaborator, manager, health advocate, scholar,

nd professional. In 2001, the American Board of PediatricsABP) recognized 6 general pediatric competencies: patientare, medical knowledge, interpersonal and communicationkills, practice-based learning and improvement, profession-lism, and systems-based practice. In both of these models,he central competencies are related to patient care, with anmphasis on the importance of basic skills in a critical ap-raisal of the literature required to provide evidence-basedare. The RCPSC, within the scholar competency, requireshat physicians “demonstrate a lifelong commitment to re-ective learning, as well as the creation, dissemination, appli-ation and translation of medical knowledge.” In recognitionf the importance of research in the ongoing care of children,he American Academy of Pediatrics (AAP) Committee onediatric Research recommends that every training programrovide a research curriculum for all pediatric residents, toequip pediatric residents with the skills necessary to evaluatend use medical literature competently and . . . equip the res-dent with a basic knowledge of scientific methods, researchesign fundamentals, core statistical principles, and the meanso conduct literature reviews.”1 Heavier clinical demands,ver-increasing child health and science knowledge bases, andore humane working hours have made incorporation of

hese non–medical expert educational objectives into resi-ency programs challenging. We describe a 1-month rotationpecifically designed to address these objectives that we re-ently incorporated into our pediatric resident training pro-ram.

In 2003, our residency program initiated a course toeach research skills to first-year residents. Due to a change inow the university’s postgraduate medical education office

rom the Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS,anada.

eprint requests: Ellen Wood, MD, MSc, FRCPC, Department of Pediatrics, Dalhousieniversity/IWK Health Centre, 5850-5980 University Ave, Halifax, NS, Canada B3K 6R8.

r-mail: ellen.wood@dal.ca.J Pediatr 2008;153:153-4)

cheduled vacations, we needed an extra 4-week rotation forhese residents. Previously, first-year residents were requiredo take their vacation in a 4-week block. In 2003, the policyhanged, allowing residents could take vacation in 1- or-week blocks throughout the year. Our Residency Trainingommittee (RTC) made the decision to use this new rotation

o develop an academic skills course that focused on the otheranMEDS competencies besides medical expert. The courseas initially developed to increase residents’ competence in

ritical appraisal and research skills, a key competence of thecholar role. Previously, we had conducted sessions on criticalppraisal every 2 years as part of the academic half-day cur-iculum (in which residents attend a weekly 4-hour academicession consisting of didactic lectures, seminars, and journallubs). When these sessions were first implemented, it was aew area, and the skills were not taught as part of the medicalndergraduate curriculum. By 2003, however, graduates ofanadian medical schools routinely received teaching in crit-

cal appraisal; thus, the course was clearly outdated and re-uired renewal. Our RTC felt that we still needed to teachritical appraisal, because residents from other countries mayot receive this training in their undergraduate medical edu-ation. We also were concerned that our residents’ researchxperience and activity was not yet adequate and could benhanced. Consequently, we undertook a revision of ourrogrammatic curriculum in the scholar competency, includ-ng research knowledge and skills, resulting in the academickills course described herein.

Although we felt strongly that residents should be in-olved in independent research projects, this was not a man-atory component of our program. Some residents had atrong research background before entering the program anduccessfully completed research projects during residency,hereas others had no interest in pursuing research projects

nd rarely became involved in any research during residency.ur focus in course development was on those residents with

ittle or no research background but an interest in doingesearch. At the time, such residents often did not successfullyomplete their research projects. Reasons for noncompletionncluded an inappropriate study (either too large or withnsufficient available resources), the wrong research question,he wrong data, inappropriate data entry, improper studyesign, inability to pass the Research Ethics Board (REB)

eview, inability to obtain a grant, and, even insufficient time.

153

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ith only 3 years to finish the project, far too many residentsere unable to complete their projects. We decided to use our

extra” 4-week rotation to teach residents how to design aealistic project that could be completed in the available timerame. Along with teaching research design and critical ap-raisal, we also aimed to address other non–medical expertanMEDS competencies. Another important aspect of the

cholar role is the ability to teach, including children, families,olleagues, junior trainees, and other health professionals. Welected to use 1 of the weeks for “teaching teaching.” Ourather grandly named “academic skills course” is mandatoryor all first-year residents.

The RTC recognized that first-year residents are veryusy and often feel overwhelmed by the amount they mustearn and experience stress while making the transition fromtudent to physician. We wanted the course to be enjoyable asell as educational for the residents; consequently, we decided

o schedule it early enough in the academic year to give theesidents time to organize their research projects to start inheir second year; but also late enough in the academic year sohat they would be able to concentrate on the course withouteeling stress about not being on a clinical rotation. (First-yearesidents tend to focus their learning primarily in the medicalxpert role.) Thus, we scheduled the course for mid-Januaryo mid-February. All first-year residents take the course at theame time; it is their “rotation” for that month. Becausereviously each resident would have been off at some pointuring the year for his or her 4-week vacation, our program wastructured for each first-year resident to complete only 12 4-weekotations. This is the resident’s 13th rotation, and thus he or sheas no daytime clinical duties. Call is reduced, usually to only 1riday and 1 Saturday during the rotation, ensuring no post-all days to compromise attendance. The residents attendheir weekly academic half-day during the course, with at least

of the half-days incorporated into the academic skillsourse. Each year a new topic is introduced, and that sessions offered to all of the residents in the program during half-ay, allowing all residents (including those who took theourse in previous years) to benefit from new additions to theourse. The 4-week curriculum of the academic skills courses outlined in the Table (available at www.jpeds.com).

The first 2 weeks of the course involves didactic sessionsn basic research topics, such as literature searches, criticalppraisal, research question development, study design, sta-istics, and the function of ethics review boards. During these

weeks, the residents perform and submit a critically ap-raised topic. The residents have unscheduled time to developresearch question and a research proposal to address that

uestion. Keeping in mind the possible barriers to completingesearch listed earlier, the third-week residents present andiscuss their research proposals with the group. This allowsvery resident to benefit from the discussion of each project.nitially, each resident presents his or her proposal to the core

54 Wood and Kronick

roject is of a reasonable size and complexity to allow com-letion during training. Next, the resident presents the pro-osal to 2 faculty members involved in full-time research, whovaluate whether the planned study design will answer theuestion being asked and also whether the planned dataathering and statistical analysis methods are appropriate.inally, the resident presents the proposal to members of theEB, allowing discussion of ethical issues and suggestions forreparing the proposal for REB submission.

The final week of the course is focused primarily oneveloping teaching skills. In the first 2 years of the course,ur Faculty of Medicine’s Division of Medical Educationresented this part of the curriculum. But the residents felthat these nonclinician educators did not understand thenique nature of resident teaching, and that much of thenformation was not relevant; therefore, we switched to pe-iatrician educators. Subsequent resident evaluations indicatehat the teaching is more relevant when done by pediatriciansho understand the resident’s role in teaching more junior

rainees.Each year the residents evaluate each session, including

he topic and the faculty speaker. We use a weekly anonymousritten evaluation completed by each resident, as well as

ace-to-face feedback from the entire resident group with therogram director at the course’s midpoint and end. Theourse has changed, and improved, annually in response tohese evaluations and feedback. Since the course was intro-uced, all residents are actively involved in research projects,nd there has been a substantial increase in the successfulompletion of resident research projects. As of July 2007,ompletion of a scholarly project is a mandatory componentf our program.

Although we had the opportunity to condense thisurriculum into a 4-week course, the sessions also could beresented longitudinally during academic half-days. It is

ikely, however, that the more intense and focused delivery ofhe curriculum during a single 4-week rotation enhances theourse’s effectiveness and allows residents to be less distractedy clinical duties and related educational demands. The cur-iculum provides the resident with at least a basic appreciationf the continuum of pediatric research and has resulted in aarked increase in the number of successful research projects

ompleted by our pediatric residents. We feel that this cur-iculum meets the standards set by the ABP and the RCPSC.t also meets, and sometimes even exceeds, the recommenda-ions of the AAP’s Committee on Pediatric Research.

022-3476/$ - see front matteropyright © 2008 Mosby Inc. All rights reserved.0.1016/j.jpeds.2008.02.026

REFERENCE

aculty involved in the course, to ensure that the proposed1. American Academy of Pediatrics Committee on Pediatric Research. Promotingeducation, mentorship, and support for pediatric research. Pediatrics 2001;107:1447-50.

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irst jump: A clinical scenario is presented, for example: “A teenage male with asthma is readmitted to your service. He realizes that cigarette smoking may be contributing to hisoor asthma control. He asks you if ‘the patch’ might help him stop smoking.” The resident must identify the clinical question, state what he or she thinks the answer will be, andutline 3 sources of information that he or she will use to confirm the answer. Sources may include electronic databases, clinical guidelines, or local experts in the field.econd jump: The resident has 30 minutes to search for evidence to answer the clinical question.hird jump: The resident must outline how he or she will explain the evidence to the patient to answer his or her question.Triple jump. This is an exercise in evidence gathering. A resident is assigned a clinical problem and has 30 minutes to find the evidence to support his or her answer. The time frame

s kept deliberately short to simulate typical clinical practice.

54.e4 Wood and Kronick The Journal of Pediatrics • August 2008