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Regular Article | March 01, 2001

A Novel Residents' Research Seminar

Rif S. El-Mallakh, M.D.

Academic Psychiatry 2001;25:57-60. 10.1176/appi.ap.25.1.57

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Dr. El-Mallakh is Director, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40292; e-mail: rselma01@athena.louisville.edu. Address reprint requests to Dr. El-Mallakh.

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Abstract

Understanding of research methodology is essential for the practice of modern medicine. Yet teaching research methodology to clinically-oriented physicians can be quite challenging. To maximize resident participation in the learning process, a 7—10-week seminar was created in which residents design, perform, and interpret the results of a research project. This approach has been successful as measured by resident attendance, participation, and expressed interest. Problems include a potentially inconsistent year-to-year experience and the requirement of an extensive commitment by the course coordinator. Nonetheless, this model may serve, with appropriate customization, as an example for other residency programs.

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A solid understanding of research methodology is becoming more important in the practice of modern evidence-based medicine. Rapid advances in both research technology and treatment options makes this particularly true in psychiatry. Yet, preparing residents for this future is a challenge. Among the obstacles facing research educators are the frequently inadequate presentation of research principles in medical school, a busy clinical schedule for residents, and variable levels of interest in research among the residents. Furthermore, didactic presentation of research methods, design, and data analysis can be dry and tedious. Learning research in the classroom is like learning a sport by lectures. Research is an endeavor that is best understood by doing (1—4).

Many residency programs in many fields have some research education program in place. These programs are usually mandatory and designed to last 1 or more years. A program that has been in effect for 15 years in an obstetrics and gynecology residency requires the residents to complete a thesis project (3). Research funds from at least four sources were available for the residents, but there was minimal structure. Consequently, "occasionally residents do not obtain enough faculty guidance … other times residents present what is essentially the faculty member's work. This is an ongoing problem." (3) A similar program in a community-based department of family medicine (2), also experienced similar inconsistencies. When the experience is more highly structured, as in a year-long program in an internal medicine residency (4), outcome is more favorable. In this program, the residents were involved in all aspects of research, from identifying the research topic to writing the protocol, securing funding, recruiting patients, analyzing data, and presenting the results (4). This effort was quite extensive and ultimately involved 51 of the 66 residents (77%) (4). Most of the residents (88%) believed involvement in the project was professionally beneficial, and 90% wanted the research program to continue (4).

Descriptions of research programs briefer than 1 year are rare. When presented, these programs are didactic-based (1). The challenge appears to be the creation of a brief research experience that actively involves the residents in all aspects of the research endeavor.

Seminar Description

The philosophy of active involvement guided our attempts to develop a seminar in which residents learn about research by doing research. The seminar had three general goals. We wanted to 1) instill an interest for scientific approaches to clinical problems; 2) develop an appreciation for the difficulties inherent in clinical research; and 3) engender a critical mindset for reading scientific literature. To achieve these goals, we designed a seminar with three aims. Throughout the course of the seminar we wanted the residents to 1) define a clinical problem and devise a scientific approach to solve it; 2) gain an understanding of basic statistical approaches to data analysis; and 3) understand that scientific knowledge depends on the interweaving of a multitude of experimental approaches and studies.

We were careful to limit the time the residents devoted to this seminar to avoid its becoming a "chore." Although this is clearly suboptimal, it was a pragmatic decision because we recognized that dictating interest is impossible. We also felt it was important for the residents to have a goal throughout and a "product" at the end of the seminar. Yet it was equally important that the residents be involved in all phases of the research process—from defining the research question to data collection, analysis, synthesis, and presentation (1). We recognized that the data-collection component of the project would require the greatest time commitment; nonetheless, emphasis had to be placed on the intellectual and scholarly aspects of the research.

Even though the seminar was mandatory, a high level of involvement was felt to increase learning. Two approaches were used to induce and maintain a high level of interest. First, the residents had to perform their own research project, and not be laborers or observers in faculty's research interests. Second, we elected that the seminar be brief (7—10 1—1½-hour sessions that met consecutively every week; Table 1). This mandated that the projects be simple and limited. It also meant that a significant portion of the "legwork" be performed by the course coordinator.

First Session.

Generally, the residents are not pre-informed regarding the structure of the course. The first session is used to introduce the concept and schedule of the course and initiate brainstorming. The discussions are started with statements such as: "What clinical problems have you encountered that interest or puzzle you?" "What do you want to know more about?" The coordinator must be careful to include all the residents in the discussion. Invariably, the residents' comments lead to projects that are impossible to perform in a limited time period. The course coordinator must guide the discussion to reasonable projects and goals. For example, when the residents chose to investigate the effect of serotonin reuptake inhibitors on coagulation, an in vitro project was suggested to allow completion during the seminar's time period (5). The point is to take the residents through the process of research, not to determine major scientific truths. The coordinator must also anticipate problems and remain flexible. If needed, informed consent or human studies committee approval must be available in a timely fashion. It is advisable that a backup project be available in the event the residents are unable to develop their own project. For example, a project measuring intracellular lithium levels was prepared as a backup project 2 years prior to its performance by a group that could not come up with its own project.

Second Session.

The idea that all projects begin with the literature is instilled here. Frequently, this session incorporates a literature search of the project. Readings are assigned (it is best to keep readings to a few key papers). It should be noted that the course coordinator must have already written a protocol and submitted it to the human studies committee (if indicated) after the first session. This protocol is not shared with the residents, who must develop it on their own. As the residents proceed, their protocol is "peer reviewed" by the course director, who recommends modifications to the design.

Third Session.

Critical reading of the literature is introduced in this meeting. As key references are discussed, problems with design and interpretation are highlighted. These discussions lead to the development of a research protocol by the residents (the course coordinator has actually already written the protocol after the first session).

Fourth–Seventh Sessions.

The actual work of data collection is performed. These sessions can be highly variable. They may involve the residents' interacting with patients, being in the laboratory, or reviewing records. Literature review projects would involve critical discussions of research papers. Division of labor is decided by the residents and guided by the coordinator. Care must be taken that everyone gets involved, and no one is overloaded.

Eighth Session.

The course coordinator usually completes the data analysis before the session. If possible, the data are analyzed in several ways, and these are presented to the residents to instill principles that underlie the statistics applied. This is felt to be sufficient, since the goal is to have the residents understand what specific analyses mean, not to be able to perform statistical analyses (that would require a statistics course).

Ninth Session.

The residents are invited to integrate their data into the literature they have read. This is done by leading a discussion in which they are guided by open-ended questions. Should they stray, they are guided back by other questions.

Tenth Session.

The necessity of peer review as an essential feature of research is imparted by the emphasis on preparation of the project for professional presentation. If the presentation is ultimately successful, it serves the additional purpose of instilling pride and confidence regarding research and affords greater self-assurance when evaluating clinical research reports after the seminar.

Seminar Evaluation

Resident attendance (consistently about 80%) and participation (nearly always 100%) was exceptional. All the residents rated the seminar as good-to-excellent. Comments were generally positive. For example, "making the subject interesting and easy to learn", "Excellent clarity and very relevant to the clinical situation"; "Group learning occurred by conducting our own project"; "good job of organizing the core material in a brief time"; "Good opportunity to participate/plan/develop small research project" although a few individuals wished for increased didactic work ("Maybe a series of lectures one week, project every other"; "more information regarding research, values, etc."), most felt the seminar was well organized ("lecture/discussion … was appropriate and effective"; "Right on target.").

An objective measure of the program's effectiveness is the number of publications resulting from it. The seven seminars held in the 5 years in which this approach was used (two Child Fellow seminars, five General Psychiatry seminars) have produced five publications (5—9).

Although it appears that the seminar accomplishes the specific aims, fulfillment of the original general goals is more difficult to measure. However, given the broad nature of these goals, it is unrealistic to expect that a single 7—10-week seminar can accomplish them. Nonetheless, several residents (four over the 5 years; 12.4%) have independently initiated small research projects that address specific clinical questions of interest to them after participation in the seminar.

DISCUSSION

Abstract | DISCUSSION | ACKNOWLEDGMENTS | References

The preliminary results of this active research seminar approach are promising. The available short-term measures of resident attendance, participation, critique, and resulting publications all suggest that the seminar is successful. It is particularly notable that 12% of the participating residents subsequently initiated their own research projects. Long-term measures, such as a more evidence-based approach to clinical decision-making or greater competence in evaluating published psychiatric research, are not available. The high level of satisfaction with this seminar mirrors other longer efforts in other fields (4,10).

There are major limitations to this approach that may not be readily evident. First, there may be significant inconsistency of the experience from year to year. The variability occurs because the nature and complexity of the research projects are determined by the residents' project choice. Also, although attempts are made to discuss alternate methods and approaches to different clinical questions, the course participants become most acquainted with the specific approach utilized. Finally, since a tremendous investment of time is required by the course coordinator (a minimum of 5 hours and an average of 8 hours for each hour of seminar time), efforts must be made to ensure the coordinator's availability.

Flexibility is both the major requirement and the major strength of this seminar. It was equally appreciated by a small group (N=2) of Child Fellows and a large group (N=10) of third-year residents. Similarly, it was equally productive when carried out over 10 (5,7), 8 (6), or 7 weeks (8). One group of residents choose to expand their project over a full year and complete a major paper (9). Implementation of this approach at other residency programs is possible if the course is tailored to the site's resources. For example, availability of several faculty members may allow for smaller group sizes or longer seminars. Similarly, resource-poor departments can create such a program if a single, motivated, research-oriented faculty member dedicates adequate time to the seminar.

ACKNOWLEDGMENTS

Abstract | DISCUSSION | ACKNOWLEDGMENTS | References

This research has been supported in part by grants from the Alliant Community Trust Fund and the Gheens Foundation.

TABLE 1. Schedule of the research seminar

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References

Abstract | DISCUSSION | ACKNOWLEDGMENTS | References

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El-Mallakh RS, Harris MR, Holman J, et al: Completed suicides and emergency psychiatric evaluations: the Louisville experience. Kentucky Med Assoc J 2000; 98:209-211

El-Mallakh RS, Peters C, Waltip C: Antidepressant treatment and neural plasticity. J Child Adolesc Psychopharmacol 2000; 10:287-294[PubMed][CrossRef]

Hayward RA, Taweel F: Data and the internal medicine house officer: alumni's views of the educational value of a residency program's research requirement. J Gen Intern Med 1993; 8:140-142 [PubMed][CrossRef]