Education for Health

BRIEF COMMUNICATION
Year
: 2019  |  Volume : 32  |  Issue : 2  |  Page : 79--83

Engaging family medicine residents in research training: An innovative research skills program in Israel


Christina Solbach-Sabbach1, Tamar Adar1, Mordechai Alperin1, Khaled Karkabi1, Inbar Levkovich2,  
1 Department of Family Medicine, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Tel Aviv-Yafo, Israel
2 Oranim College of Education, Kiryat Tivon, Israel

Correspondence Address:
Inbar Levkovich
Faculty of Graduate Studies, Oranim College of Education, Kiryat Tivon, 3600600
Israel

Abstract

Background: The importance of medical research in developing academic and clinical excellence is widely acknowledged. Obstacles hindering research in primary care include negative attitudes, lack of dedicated time, funding shortages, and a relative paucity of mentors. Residency is the appropriate stage for developing research skills and encouraging research performance. In this article, we describe an intensive research training program offered at the family medicine (FM) Department, Technion Faculty of Medicine in Haifa, Israel. The program aims to engage residents in FM in constructing a research protocol to provide them with a positive experience, help them to overcome barriers, and enhance their research performance. Methods: Learning is achieved through a course design that includes the following six components: (1) course website: a platform for online collaborative learning; (2) inverted classroom: theory is learned through website video lectures and presentations during resident's own time according to a guided schedule, while weekly classroom sessions are dedicated to step-by-step implementation of theory, group discussion, and individual mentoring; (3) Peer feedback; (4) personal mentoring; (5) presentation of the protocol to peers and senior department staff at the end of the course; and (6) evaluation of protocol presentation and engagement during the research course as well as possibilities for further development. Results: Five teams of residents went on to conduct full research projects. Their studies have been presented at seven national and three international conferences, and one has been published. The outcomes of these studies have been useful in FM practices and have inspired residents to continue scholarly work in our department. Discussion: Innovation in teaching methods enhances engagement in learning research skills among residents and may encourage them to conduct research in primary care.



How to cite this article:
Solbach-Sabbach C, Adar T, Alperin M, Karkabi K, Levkovich I. Engaging family medicine residents in research training: An innovative research skills program in Israel.Educ Health 2019;32:79-83


How to cite this URL:
Solbach-Sabbach C, Adar T, Alperin M, Karkabi K, Levkovich I. Engaging family medicine residents in research training: An innovative research skills program in Israel. Educ Health [serial online] 2019 [cited 2019 Dec 15 ];32:79-83
Available from: http://www.educationforhealth.net/text.asp?2019/32/2/79/271198


Full Text



 Background



Research in family medicine (FM) is a critical component in developing quality primary care.[1] Even though the importance of research in this field has been acknowledged, FM research is far from achieving its true potential as the number of established researchers worldwide is relatively small, and the number of publications still lags far behind publications in other medical disciplines.[1],[2],[3],[4] There is a growing consensus that residents should be taught research principles early in their training.[5],[6] Teaching programs in many countries have recognized the importance of developing a positive research culture in FM and have implemented research engagement as a goal, despite considerable variations in residency training requirements,[6],[7],[8] including a research requirement.[9],[10],[11],[12] The recent and growing importance of research in FM training around the world can be seen in undergraduate and graduate research programs as well as in the development of a research network and cooperation between countries in sub-Saharan Africa.[13],[14],[15]

In Israel, hospitals across the country currently offer a 3–4 years' residency program in FM. A research project is not required for national board certification, and not all departments require completion of a research project for graduation.

In our FM Department at the Technion Faculty of Medicine in Haifa, Israel, completion of a research project was obligatory for all residents until 2014, but very little research was actually conducted. The paucity of research activity among FM residents is common in other countries as well.[3],[5] ,[14],[15],[16],[17]

Various factors hinder research and publication among FM residents,[6],[7] who have reported lack of interest, a less-than-positive attitude toward research,[5],[18] lack of time, lack of skills, and lack of a research curriculum as obstacles.[5] Factors that encourage research during residency are specific times dedicated to research, dedicated support staff, and funding.[19] Furthermore, successful completion of a research project during residency makes future involvement in research more likely.[20]

In our FM department, we were concerned about residents' lack of enthusiasm toward research activity and their very low research output over more than a decade. Between 2004 and 2014, only one resident research protocol (RP) received a grant, and only one resident research project was published.[21]

With the objective of boosting research among residents, we revised our training curriculum in 2014 and implemented the “inverted/flipped classroom” method.[22] This method is gaining acceptance in medical education, as it is associated with higher academic achievement than lecture-based learning.[22],[23],[24],[25],[26] To our knowledge, the inverted classroom method has not been previously used for teaching research skills to FM residents in Israel or elsewhere. The inverted classroom method seems to be a good strategy for linking the teaching of theoretical research skills with positive and practical research experience.[22],[27] In this article, we describe our experience of implementing the inverted classroom method in an FM residency research program. First, we describe the different components of our project and then further discuss specific considerations and challenges for implementing an inverted classroom model.

Project description

Our revised research course for 1st year FM residents focuses on choosing a practice-based research question (RQ) and developing a RP. Theoretical research skills are taught interactively through step-by-step, mentor-accompanied development of the protocol [Table 1].{Table 1}

Course design

The one semester course consisted of fourteen 75-min lessons. Participants were divided into working teams of two to three residents. Each team's mission was to formulate an original RQ and construct an RP accordingly. Two final sessions were allotted to the presentation of the RPs.

Teaching method-components

Component 1: Course website

We created a course website that included videos and PowerPoint presentations of lectures on theoretical material as well as an individual online worksheet for each team's RP [Table 2].{Table 2}

Component 2: The “Inverted Classroom”

An “inverted classroom method”[14] was employed. We uploaded video lectures (5–20-min long) to our course website. Residents were required to watch them and learn the theoretical material at home in preparation for class, so that weekly lesson time could be dedicated to discussion, peer learning, and individual mentoring.

The weekly lesson commenced with a summary of the theoretical topic, which was then demonstrated on one team's RQ. The main part of the session was dedicated to implementation of the topic on each team's RQ through teamwork and individual mentoring.

Component 3: Peer review

The course included periodic-structured peer reviews. Teams were paired and asked to present and discuss their protocols and receive feedback on a checklist of issues, including RQ clarity, study objectives, literature review, hypotheses, and methods.

Component 4: Mentoring

Our staff included four teachers (three family physicians and one psychologist) with research experience. Each teacher was assigned two to three teams to mentor throughout the course. The mentor reviewed the team's progress, wrote comments on the team's online protocol sheets, and provided support and advice according to each team's needs.

Component 5: Presentation

During the past two sessions of the semester, the teams presented their protocols to their peer teams, mentors, and the senior faculty of the residency program.

Component 6: Evaluation and scope for future development

On completing the course, learners received a constructive verbal evaluation of their participation and evaluations of their protocol and its presentation.

Residents demonstrating appropriate motivation and skills were offered the opportunity to complete their research project with mentored supervision. These residents were allocated dedicated time for research usually 1 workday/week for a 3-month period during each year of residency until completion of the project [Figure 1].{Figure 1}

Over the past 3 years, we have run four such courses and taught 56 residents. Five resident teams have chosen to conduct complete research projects, including several qualitative studies. The study questions have addressed a variety of subjects relevant to FM and to different ethnic groups in our society. The study results have been of practical value to our department. Three teams received funding as high as 38.000 NIS from the Israel Association of FM. Since the beginning of this program, studies conducted in our department have been presented at seven national and three international conferences, and one has been published.

 Discussion



We propose using the teaching model described in this study to teach research in FM departments and to help encourage research among residents.

Lessons learned

First, the “inverted classroom” method facilitates optimal use of time. Recognition and implementation of this method are rising. In 2012, staff members from the Stanford School of Medicine wrote about their experience with this method in the New England Journal of Medicine. After redesigning their core biochemistry course based on the “flipped classroom” method, they advocated “Lecture Halls Without Lectures” to free up class time for knowledge application.[23] This teaching method has been gaining acceptance in medical education.[22],[24],[25],[27],[28] To the best of our knowledge, it has not yet been implemented for teaching research skills.

In our revised program, residents learn basic skills by video lectures before the weekly lesson, while lesson time is used for more in-depth mentoring, discussion, and peer review. Individual feedback from residents indicates that they were especially pleased with the flexibility of being able to access the lectures from their PCs (Personal computers) and mobile phones at their convenience. Nevertheless, we still felt that a one semester course was too short for some teams to delve into their RQ, resulting in superficial work. One of the most time-consuming steps was formulating the RQ. It was important to us that the teams choose an original RQ from their daily clinical experience. Because the learners are 1st year residents, their experience is still limited. Team members also needed time to resolve differences in their feelings regarding various RQs. We considered coping with this issue by having the teachers to prepare a pool of RQs ahead of time as options for teams struggling to find an RQ. However, we are hesitant to do so, because we believe the ability to identify a daily clinical issue worthy of investigation is crucial to the development of critical thinking. We have also considered extending the course to two semesters or offering the course in the 2nd year of residency, ideas which necessarily must be coordinated with the full residency curriculum.

Second, the inverted classroom method has been shown to promote accelerated learning, which encompasses teamwork, debate, and self-reflection.[22],[23] These skills are necessary for complex tasks such as planning a RP. Independent learning is required as a part of the success of this course design. Residents who come to class unprepared have difficulties participating in exercises and teamwork. A short obligatory online questionnaire at the end of each E-Lecture is a possible way to motivate residents in future courses to prepare for class.

Third, the revised program resulted in a more positive approach toward research on the part of our residents. Satisfaction surveys at the end of the course indicated that the residents were highly satisfied (Mean = 4.97, standard deviation = 0.12, range 1–6). Several studies have suggested that accelerated learning increases learning success, motivation, and positive attitudes.[1],[2],[5] Thus, our choice of the inverted classroom method aims to foster a positive experience and enhance residents' motivation to engage in future research projects. In addition, as stated above, we waived the requirement for completing a research project and instead focused on identifying an RQ and constructing an RP. At the end of the course, we supported residents who were interested in continuing a research project based on their protocol. These residents were given dedicated research time, and we assisted them in applying for funding and additional factors associated with successful resident research.[2] This change led to an increase in the number of research projects in our department. In the discussion and feedback sessions, the residents indicated that they benefitted from the program and acquired more research skills than they had anticipated. Still, it must be mentioned that although more research is conducted, it is still ultimately conducted by only a minority of the residents. This is due to a lack of dedicated time and also to variations in the residents' academic capabilities. We continue to deliberate whether we should require all residents to complete a research project. On the one hand, this would convey a positive message, supporting the importance of research. On the other hand, it seems impractical as in the past; our experience was that many residents did not complete the assignment. It seems more effective to give the opportunity to the most motivated residents.

Fourth, personal mentoring provides support and tailored instruction, as well as modeling of research capabilities.

A limitation of our revised course design is the number of skilled mentors required for close guidance. As part of the strategy to facilitate research, in 2015, our FM department established a research unit and hired a research manager as a part of the mentoring team to coordinate and supervise the projects. Direct correlation with research outcome needs to be evaluated. As the research manager is an important initiator and motivator to the residents and their projects, we hypothesize that he has a major influence on overcoming the incompletion of their assignments.

Our observations are based on our own residency program, and the described program has not yet been implemented in other departments in Israel.

Follow-up studies are necessary to learn whether positive research experience for residents and young family physicians will influence their attitude and involvement in scholarly work in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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