Not the Last Word: Rethinking the Resident Research Requirement

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A few years ago, I suggested in this column that core competencies for residents as defined by the Accreditation Council for Graduate Medical Education (ACGME) were “overrated” [2]. I was correctly criticized by the commentators then—so much so, that if I were granted the Last Word now, I would simply say, “Dr. Chehade, Dr. Pinney, and Dr. Black: I was wrong and you are right.” Thus, it is with a touch of humility (induced if only temporarily by that memory), that I suggest that we rethink another of the ACGME requirements.
Well, here it goes: The ACGME requirement for resident research can be improved.
According to the ACGME [1], residents must either participate in sponsored research, prepare an article for a peer-reviewed publication, present research at a regional or national meeting, or participate in a structured literature review of an important topic.
Overall, these are reasonable means of attaining the worthwhile goal the ACGME describes, namely, the advancement of “residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care” [1]. But there is room to improve the system. Consider these limitations of each of the four activities the ACGME identifies:
Participating in Sponsored Research
Participation in sponsored research surely can give the resident an appreciation of how research is conducted. Yet the requirement speaks specifically about “participation” and limits the domain to “sponsored”, that is to say, funded, research. These words suggests that the resident will be a small cog in a big machine—something more than a test-tube washer, no doubt, but not necessarily a full participant, either.
Submitting a Manuscript to a Journal
Submitting a manuscript to a journal requires not only participating in research but completing it. Nevertheless, this standard may push residents towards less-meaningful projects. That's because journals favor positive results [7]. Resident researchers, mindful of this bias, would tend to engage in projects likely to turn up positive results—like a reporting on a series of cases. We have enough of those low-evidence, retrospective studies already.
Presenting at a Meeting
Presenting at a meeting can be a worthwhile experience. The resident will not only have a chance to share his or her work, but the opportunity to see the work of other researchers. That could be a mixed bag, however, as the science at meetings is just not the best. Bhandari and colleagues [3] have shown that two-thirds of orthopaedic meeting abstracts “were not followed by publication of a full-text paper … [the] quality of reporting in abstracts proved inadequate, and inconsistencies between the final published paper and the original abstract occurred frequently.” Further, to the extent that meetings seek flashy results, this standard may induce residents to draw unwarranted inferences from their research data, to make the submission more “meeting worthy.”
(On a personal level, I can't criticize national meetings too harshly; one of the best weeks of my life was February 15-22, 1993 at the meetings of the Orthopaedic Research Society [ORS] and the American Academy of Orthopaedic Surgeons. I was in San Francisco, on an expense account, away from on-call duties, and the Grateful Dead was playing three nights at the Oakland Coliseum. Of course, in retrospect, that trip to California might not have been the best use of time and money).
Conducting a Systematic Review
The creation of a systematic review is harder to criticize, as it offers at least three concrete benefits: The resident will learn the material in question; the process will teach the resident broadly-applicable skills in assessing published papers; and the end product, the review itself, will likely be useful to the medical community.
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