Program directors seem to agree on which types of scholarly activities fulfill the RRC requirement. They report in-depth topic reviews with presentation and case reports as the most common scholarly activities completed by residents. In addition, many residents conduct hypothesis-driven research and disseminate their work through presentations and publications. These are laudable tasks to accomplish during an already demanding clinical training period.
There are many arguments as to why resident research is worthwhile. Research experience can impart skills that are invaluable to the practice of medicine such as literature searching and critical appraisal.7–10,18–24
Early research training has been associated with continued scholarly work and may help to inform residents' career choices.18,25–29
However, research activity may take time away from clinical learning, the primary goal of residency training, and many practical barriers to successful efforts exist.11,20,30,31
Further studies are needed to better characterize the educational value of resident scholarship in terms of measurable educational and patient care outcomes.
This survey is the first effort to systematically review the state of resident research at internal medicine training programs since the introduction of the scholarly activity requirement in 1994. Compared to previous work, it appears that residents have become more involved in scholarly activities. In 1993, program directors reported that in the previous year, 18% of residents had conducted hypothesis-driven research and 33% had completed topic reviews.11
The current averages of 31% (95% confidence interval [CI], 27 to 35) performing hypothesis-driven research and 72% (95% CI, 67 to 77) preparing topic reviews described in this study suggest a substantial improvement. It is possible that the actual research activities of residents prior to 1993 may have been underreported because the need for program directors to provide evidence of resident scholarly activity was not yet obligatory. Nonetheless, it is our belief that most program directors should have been aware of their residents' activities, in which case the findings of this study likely represent a true increase in resident scholarship.
We had hypothesized that university-based residency programs would fare better than nonuniversity-based programs with respect to support for resident research and in terms of the scholarly productivity of their residents. The survey findings did not support this theory. For example, nonuniversity-based programs were more likely to have a mandatory requirement for residents to conduct hypothesis-driven research, provide a structured research curriculum, and have as many or more residents involved in various scholarly projects than did university-based programs. Despite this apparent success, nonuniversity-based programs describe greater barriers to resident research and report having been cited more often by the RRC since initiation of the requirement in 1994 for inadequately fulfilling the scholarly activity requirement. One explanation for this finding might be that because nonuniversity-based programs have less research-related resources and expertise, they must provide more support, such as through research curricula, for their residents to succesfully complete scholarly projects. If this is the case, the current level of support and research activity at nonuniversity-based programs may represent succesful efforts to overcome barriers to resident scholarship. Alternatively, nonuniversity-based programs may have been cited more often despite efforts to support scholarly activity because the quality of that support may not compare favorably with university-based programs. For example, in other studies on resident research, mentoring has been shown to be important for success.12,15
Perhaps the research and mentoring skills of faculty at nonuniversity-based programs may not be the same as those of faculty at university-based programs.
We could not determine from our survey exactly how much effort each program must expend to fulfill the RRC requirement or whether resources including funds or time are diverted from other components of residency training. Developing and sustaining a productive resident research program requires significant creativity and resources.10,11,32–35
Given the many objectives of residency education, the time and resources allotted for any one specific requirement must be carefully considered in the context of the overall residency curriculum.
Several limitations of this study should be considered. First, although the response rate to this survey was high, we cannot be sure that our findings are truly representative of the research activities and environments at all internal medicine residency programs. Second, we relied on the report of program directors to gauge the number of residents involved in various activities and to estimate the level of support for resident scholarship. Although failure to demonstrate resident scholarly activity may result in citation by the RRC, we have no reason to believe that program directors would have given inaccurate responses to this confidential survey. Furthermore, programs must provide evidence of resident scholarly activity during accreditation review site visits. All programs in this study had at least one site visit within the last 7 years (data not shown) and therefore program directors should have been familiar with information on resident scholarship compiled in preparation for accreditation review. Third, our findings are based on data collected using an instrument that has not been validated. However, we made considerable efforts to design a valid instrument and verified responses where possible. Finally, due to the cross-sectional design of our study, our conclusions are limited to observations of the current state of resident research. We are unable to link causally our observations about resident research and scholarly activity with the implementation of the RRC requirement; in particular, our study was not designed to identify the causes of citation for lack of scholarly activity among residency programs.
The current state of resident research in internal medicine training programs appears to be robust. Residency programs support resident scholarship with funding, curricula, protected time, and research mentors. Residents complete a variety of scholarly projects and many present or publish their work. Nonuniversity-based programs are doing as much as university-based programs in fulfilling the RRC requirement in spite of greater barriers. Nevertheless, the value and cost of resident scholarship in terms of educational and patient care outcomes remain unknown. An ongoing challenge to graduate medical education, particularly in light of new limitations placed on resident work hours, will be to evaluate critically all components of residency training to prove their merit.