TheJournalofEmergencyMed,cine, Vol. 1.pp.459-464.1984
Printedin the USA ??Copyright 0 1984 PergamonPressLtd
A SYSTEMATIC APPROACH TO RESEARCH CURRICULA FOR EMERGENCY MEDICINE RESIDENCIES Mark W. Brautigan,
Department of Emergency Medicine, Mount Carmel Mercy Hospital, Detroit, MI 48235 and Assistant Professor, Section of Emergency Medicine, Michigan State University, East Lansing, MI
0 Abstract-The understanding, design, and execution of research is a necessary part of emergency medicine residency training. An outline of a residency research curriculum is presented. The four objectives of this program are for the resident to critically read and evaluate research literature, learn to design and conduct a research project, become actively involved as a participant in a research project, and write and publish a research paper. This model curriculum is designed to accomplish these objectives in an organized manner and is based on the assumption that the resident has had no research experience. The program we have developed for resident research is designed to be covered in 36 hours of instructional thne over a 3-year residency curriculum. The initial sessions are covered early in the residency and are concerned with the critical evaluation of research. These sessions are the foundation of the research curriculum and journal club meetings. The remainder of the didactic material is to be taught as the resident acquires practical research experience. These later sessions, conducted in a research committee format, guide the residents through the design, implementation, analysis, and presentation of their work. 0 Keywords- research; residency curriculum
This paper was originally presented at the University Association for Emergency MedicineAnnual Meeting, April 1982.
Introduction Residency training programs in emergency medicine are continuing to evolve as the specialty matures. The development of’the core content in emergency medicine’ and its subsequent organization into a residency core curriculum2 were keys to organizing residencies in clinical emergency medicine. More recently, Lowry and Lauro developed an emergency medicine service curriculum for residency programs.3 Although the need for an emergency medicine research base4 and for the continuous production of research from residency programs at academic centers have received editorial support,5-8 this issue has yet to be addressed in curriculum models. This paper presents a research curriculum for emergency medicine residencies that has been successfully implemented in a residency program.
Objectives and Methods The four objectives of the research curriculum are to teach residents how to: I. critically read and evaluate research,
-_ _ ” ^ Education features papers focusing on the training of emergency physicians and the administration of residency programs. 13 December 1983; ACCEPTED:16 February 1984 0736-4679/84 $3.00 + .OO 459
Mark W. Brautigan
Table 1. Residency Research Curriculum: Didactic Teaching Plan, Part I
I. Evaluation of Research A. Introduction 1. Is there a sound theoretical background? 2. Is the hypothesis clearly stated? 8. Type of Study 1. Single blind/double blind 2. Prospective/retrospective C. Objective of the study D. Study design 1. Criteria for entry into a study, validity of criteria a. Sampling methods 2. Controls 3. Variables, controlled and uncontrolled 4. Method of evaluation a. Objective methods b. Subjective methods E. Evaluation of presented data 1. Do data support claims? 2. What are alternative explanations? Did the author refute them? 3. Do alternative explanations fit data better or worse? 4. Are data presented clearly and subject to statistical analysis? 5. is there internal and logical consistency to the data? F. Conclusions 1. Did the study meet the objectives set forth? 2. Do the data support the conclusions? 3. Did you learn from the study?
II. design and conduct a research project, III. become an active participant in a research project, and IV. write and publish a research paper. The first two objectives are addressed by presentation of material in a lecture format. It is assumed that the resident has had no research experience; therefore, Part I, the evaluation of research, is taught initially (Table 1). Parts II and III, the approach to research and the research project (Table 2), and Part IV, the writing of a research paper (Table 3), are taught sequentially throughout the remainder of the residency curriculum. One didactic hour per month is dedicated to the research curriculum, and all of the initial material is covered during the first year of training. The research curriculum sessions may be presented during the initial journal club sessions, because the material is applicable. Didactic material on how to become ac-
tively involved in a research project (Table 2, III) addresses the third objective of the curriculum. This material is presented in discussion or “mini-sessions” running concurrently with the lecture material of Parts I and II in the first year. During these sessions, faculty and senior residents give brief presentations of their research projects. These presentations frequently recruit junior residents to assist in ongoing research projects and stimulate ideas for related or new research projects by the residents. As individual residents select the research projects, they are instructed to write a research proposal including a literature review, statement of project objectives, and proposed methods. Their research proposals are presented at one of the mini-sessions. The faculty and residents act as a research committee, providing criticism and suggestions on the presented research. When this “research committee” grants approval, the resident may begin the project. The residents must initiate their research as early as possible in the residency, realizing the constraints of a 3-year period.
Table 2. Didactic Teaching Plan, Parts II and Ill Ha. Approach to Research A. Why research? 1, Necessary for the establishment
of any specialty 2. Generation of new data 3. Scientific basis for practice 4. An ongoing evaluation of practice methods and techniques 6. The scientific method 1. Make observations 2. Form an hypothesis 3. Test the hypothesis 4. Retest and reevaluate the hypothesis 5. Draw conclusions/formulate a theory Ilb. The Research Study A. Make observations-the idea for a study 1. A clinical problem that is a. Poorly understood b. Has a wide variety of managements (or mismanagements) c. Unusual or rarely seen d. An area of controversy 2. An area of emergency medicine that has never been investigated and reported in the literature 3. An area of emergency medicine that has been investigated but never collected and critically evaluated 4. Data collected in the emergency department but never used to its fullest capacity as a tool of prediction or evaluation 5. Physiologic or pharmacologic principles never applied in a clinical or animal model situation 6. Form a hypothesis 1, The basis for study design 2. The hypothesis must be testable within the department or facilities available 3. The study must be ethical and able to pass the hospital’s research committee 4. The hypothesis should not have been previously investigated and published unless the new study will significantly change that previous work 5. Review of the literature, key to any research 6. Controls C. Test the hypothesis 1. Prospective studies a. Most difficult to perform b. Contribute the most to the literature c. May require a source of funding d. Design to use a minimum of data outside the data collected for the usual management of a patient e. Most publishable type of research 2. Retrospective studies a. Easier to perform than the prospective studies b. Uses previously collected data c. Often incomplete due to incomplete history and physical exam or other data that may be missing from the chart 3. Collective reviews a. Library research b. More significant if each publication is critically evaluated and conclusions drawn from the review c. Most applicable if no review in the last 5 to 10 years or if the review covers a rapidly changing area d. Should include 50 to 60 references e. Important as a guideline in clinical practice f. May be a stimulus for a clinical research project 4. Case reports a. Report of a single or small number of interesting or unusual cases b. Requires limited review of the literature c. Important to emergency medicine because of limited exposure in the typical emergency department 5. Research seminars a. Development of a new area of medicine (continued)
Mark W. Brautigan
Table 2. Continued b. May include a wide variety of subjects and ideas c. Operation, management, organization of a department, residency, or other areas pertinent to emergency medicine d. Historical aspects of medicine 6. Letters to the editor a. A valid type of publication b. Ongoing critique and evaluation of the most current literature c. As important as other publications 7. Laboratory research a. Most basic research to the field b. In vitro studies i. Biochemistry/physiology -Mitochondrial metabolism -Protein synthesis -Drug effects ii. Organic chemistry -Solubility of drugs -Methods of drug administration c. In vivo studies i. Dogs as the current physiologic model ii. Funding required iii. Time investment iv. Access to an animal facility d. Bridging the gap i. From the laboratory to the patient ii. Limited application to human medicine initially D. Concepts of study design/reevaluation 1. How many cases to be a valid study a. Trends in your data b. “Pilot study” c. Need to change the hypothesis or abandon the study 2. A good study that has been well designed should never have to be abandoned a. Changing your methods b. A multicenter study as an alternative c. Publish the pilot study d. Build a data base for multiple publications-organize and subdivide the data Ill. Becoming Involved as an Active Researcher A. Independent investigation 1. Collective review 2. Retrospective study 3. Case reports with limited collective review 4. Prospective study a. Difficult to do independently 5. Research seminars B. Cooperative research efforts 1. An independent investigator with assistance 2. As a member of a large research group a. A large project has a number of publishable parts 3. Laboratory research a. One can easily assimilate into an active research laboratory; usually requires a project design beforehand C. Research committee and mini-sessions
The fourth objective, teaching how to write a research paper (Table 3), is covered in the curriculum in either the second or third year. Because the research committee will require more time as the residents’ work progresses, the final lectures are com-
pleted in a number of ways: The material may be presented as a short lecture followed by the research committee meeting monthly, or the research committee can meet every 2 months with the lecture given on alternate months.
Table 3. Didactic Teaching Plan: Part IV IVa. Writing a Research Paper A. Uniform requirements for manuscripts submitted to biomedical journals9 B. Abstract 1. Brief summary of each section of the research paper C. Introduction 1, Complete review of the literature in capsular form 2. Purpose of the study 3. Objectives and limitations D. Materials and methods 1. How the study was conducted 2. Criteria for entry or elimination from the study 3. Adequate controls 4. Details of all aspects of implementation of the study a. Data must be reproducible within the study design E. Results 1. Organize your data and present them 2. No conclusions or discussion-only present the data 3. Tables, graphs, percentages to present the data F. Discussion 1. Linking the data with the introduction 2. Statistics a. Mean, median, mode b. The concept of significant c. Tests of significance i. Student’s T test ii. Chi-square iii. Other tests 3. Present convincing arguments G. Conclusion 1. Summary of study IVb. Funding a Research Project A. Hospital funding B. At the periphery of an active group C. Research foundations D. Pharmaceutical companies IVc. Where to Publish A. Where to submit your work B. In your field or elsewhere C. Presentation at meetings D. The waiting process 1. Evaluation by editors, editing 2. Rewriting 3. Typescript approval
This research curriculum is in use by the emergency medicine residency at Mount Carmel Mercy Hospital. The formal presentations have stimulated faculty and resident research interests. In the first year of our emergency medicine residency, four of five of our residents have completed research projects under faculty supervision. One project has been accepted for presentation at the International Congress of Angiology. Resident research interest seems to
have enhanced faculty interest, and new research projects are being conducted this year. We have found that with regularly scheduled research meetings, research interest is maintained and research projects are carried out in a timely fashion. The setting of short-term goals, such as the presentation of research at conferences, assist in the completion of the research. With formal didactic presentations and individual faculty-sponsored involvement, interest is sustained and projects are completed within the time frame of a 3-year residency program.
Mark W. Brautigan
Conclusion A model research curriculum for emergency medicine residencies has been developed. Four objectives have been identified for the curriculum. This model has been productive during its first year in the emergency medicine curriculum at Mount Carmel Mercy Hospital. The organization of research into a resi-
dency curriculum seems helpful in stimulating residents to design, conduct, and publish research. Successful instruction of residents in research skills is vital to the future of academic emergency medicine. Acknowledgments-The
author thanks Blaine White, MD for his valuable comments on this work and Virginia Crilley for the preparation of this manuscript.
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