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 Table of Contents  
Year : 2020  |  Volume : 33  |  Issue : 2  |  Page : 46-50

Tiered team research: A novel concept for increasing research productivity in the academic setting

1 Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
2 Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
3 Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery, Blanchfield Army Community Hospital, Fort Campbell, Kentucky, USA
4 Orthopaedic Trauma Department, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA

Date of Submission02-Aug-2019
Date of Decision04-May-2020
Date of Acceptance02-Jul-2020
Date of Web Publication08-Dec-2020

Correspondence Address:
Rachel B Seymour
1320 Scott Ave, Charlotte, North Carolina 28204
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.EfH_80_19

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Background: Research has become a key pillar of academic medicine and a cornerstone of residency training; however, there continues to be significant barriers to ensuring research productivity for residents. We implemented a novel tiered team approach which aimed to increase research productivity and promote collaboration during residency training. Methods: This was a retrospective study that evaluated the implementation of a novel tiered team research approach at a single institution between 2009 and 2013. Analytical software was used to visualize and display the research interconnections among the authors of the captured publications. In addition to using Gephi to determine the research interconnections, the growth in research capability of the tiered team and its individual members were also graphically depicted. Results: The research team produced a total of 77 publications during the study period (2009–2013). Significant and frequent collaboration and coauthorship was noted as the years progressed following implementation of tiered team research. Discussion: Tiered team research can be readily implemented at most institutions and can lead to increases in productivity of published research. It can also promote collaboration and peer mentorship among those involved.

Keywords: Education, orthopedics, productivity, tiered research

How to cite this article:
Alamanda VK, Krueger CA, Seymour RB, Stinner DJ, Wenke J, Hsu JR. Tiered team research: A novel concept for increasing research productivity in the academic setting. Educ Health 2020;33:46-50

How to cite this URL:
Alamanda VK, Krueger CA, Seymour RB, Stinner DJ, Wenke J, Hsu JR. Tiered team research: A novel concept for increasing research productivity in the academic setting. Educ Health [serial online] 2020 [cited 2022 Oct 7];33:46-50. Available from:

  Background Top

Research has become a key pillar of academic medicine[1] and a cornerstone of residency training.[2],[3] Resident involvement in research enriches training with scholarly activity while at the same time helping to further advance the field. In addition, studies have shown that research involvement during residency improves patient care, enhances critical thinking and analytic skills, and develops a passion for lifelong learning.[4]

The Accreditation Council for Graduate Medical Education (ACGME) requires that residency training programs in most fields, including orthopedic surgery, mandate involvement in scholarly activity during their training.[5] Being involved in research during residency also aids with the particular residents’ fulfillment with their training[6] and helps with furthering their career in academic medicine such as securing a more desirable subspecialty fellowship.

Despite these numerous advantages, there continues to be significant impediments in ensuring orthopaedic surgery residents are being productive in research during their residency training. A variety of barriers to research productivity have been proposed such as limited time outside of clinical responsibilities, lack of research skills, paucity of research mentors, and lack of research support personnel to assist with administrative and regulatory requirements.[7]

The authors implemented a novel tiered team approach to research with the goal of increasing the volume of publishable clinical research produced through network modeling. We define “tiered team” as a strategy to create groups of residents with supervision from a faculty mentor that collaborate on a research agenda and provide mentorship and support for each other. In practice, this meant assigning a resident with research experience as the team lead with other residents at various stages of training participating to complete the project and prepare manuscripts for submission to peer-reviewed journals. Having residents at various levels of training and research experience collaborate meant that the lead residents had the opportunity to serve in a leadership role, develop mentorship skills, and expand academic productivity, and team members learned the research process, contributed to ongoing projects, and received authorship for participation. The objective was to not only increase research productivity but also to foster collaboration and team-based learning among the residents participating and to provide more residents with the opportunity to have meaningful participation in research. Finally, the tier-team approach provided opportunity for the residents to learn to be research mentors for junior colleagues. In this article, the tiered team approach to research is described along with an illustration of the productivity derived from its incorporation.

  Methods Top

This was a retrospective study that evaluated the implementation of a novel tiered team research approach at a single institution between 2009 and 2013. This study was exempt from review process by the Institutional Review Board. Implementation of this tiered team research concept involved self-selected residents from the postgraduate year (PGY) 1 and 2 of orthopedic surgery, involvement of the research resident who participates in a year of research between their PGY2 and PGY3 years, as well as an attending clinician who serves as a faculty mentor.

Education regarding the research process was provided to junior residents early in the training and consisted of both the essentials of research study design, including review of existing literature, data collection, and data analysis. As these junior residents progressed through the training program to become mid-level and senior residents, they were expected to serve as near-peer mentors and subsequently coinvestigators and coauthors with new PGY1 and PGY 2 residents [Figure 1].
Figure 1: Schematic representation of the tiered team research

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The faculty mentor’s focus was on guiding the mid- and senior-level residents on the development of research questions, bringing existing research projects to completion, preparation of publishable manuscripts and managing the small research teams which would involve junior residents as described above. These mid- and senior-level residents provided near-peer mentorship to the junior residents and as the junior residents progressed through residency, new incoming residents would join and the team and fill the void as the preexisting junior members moved up the team.

Support personnel comprising research nurses who helped facilitate Institutional Review Board applications, protocol implementation and aiding with other administrative tasks also complemented the research team. Their addition to the projects was essential in allowing residents to focus on data collection, analysis of results, and authoring manuscripts.

Weekly meetings were held among all the members of the team to ensure that projects were making progress, moving in the right direction and to identify and reallocate personnel, resources as needed. These meetings were brief, often over the telephone and did not impose significant time commitments from the residents.

The productivity from implementation of the tiered team research model was analyzed by examining publications indexed in Medline by members of the research team.[8] PubMed search was conducted to identify publications produced by each member of this team for a 5-year time period beginning with 1 year after implementation of this program.

Analytical software, Gephi, was used to visualize and display the research interconnections among the authors of the captured publications.[9] Gephi is an open source software that allows for data visualization and analysis.[10] It allows for dynamic network visualization by exploring the interrelationships that are present between the coauthors among their various publications after initiation of the study.[9] This is based on social network analysis which aims to investigate social structures, as those present in publications, by connecting nodes (individual authors) to links (relationships between the authors in publications) and presenting them in a graphical format.[11] In addition to using Gephi to determine the research interconnections, the growth in research capability of the tiered team and its individual members was also tabulated.

  Results Top

The data were collected between 2009 and 2013 as described above to evaluate the productivity of the tiered research team. The research team, comprising three residents and an attending faculty member, produced a total of 77 publications [Table 1]. The 1st year of involvement of the members of the team are highlighted. Progressive increase in the number of publications of each member is demonstrated as the members advanced through the research pyramid.
Table 1: The number of publications each resident or staff member of the tiered research team had each year

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The exponential growth in research productivity and interconnections in the publications produced by the research team are depicted in [Figure 2] and [Figure 3]. The more publications that an individual has with a team member, the closer that dot is to the top of the circle. Thicker lines between two dots represent more common coauthors than thinner lines. As evidenced by the graphical depiction and the tighter interconnection of the data points, significant and frequent collaboration and coauthorship is seen as the years progressed following implementation of this approach to research.
Figure 2: Graphical depiction of research circles

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Figure 3: Graphical depiction of author interconnections

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Similarly, [Figure 3] depicts the interconnections between the various members of the research team and the extensions derived from each of the sub projects run by the various members of the team. As the years progress following implementation of the tiered team approach, significant increases in the total number of publications are seen as well as the interconnections, signifying the collaboration, between the various members of the research team. In addition, as seen in [Figure 3], the increasing collaborative nature and increasing interconnections between the members of the team is clearly visualized as the cluster encompassing the team gets tighter as the years progress following the inception of the program.

  Discussion Top

Research is an important cornerstone of academic medicine. Most ACGME accredited residency programs, recognize this and have incorporated scholarly activity through the implementation of research requirements for residents. In addition, with the limited amount of time available for activities such as research during their years in training, collaboration and running effective research teams are paramount to increase efficiency and productivity. A variety of methods from having dedicated research days to having a dedicated research program built within the residency curriculum to implementing a reward system for research have been proposed to help bolster research productivity among residents.[12],[13],[14],[15] Some residency programs have also established research milestones as part of their graduation requirement to foster research activity.[16]

Previous studies have shown that those residents who have had a good research experience previously and have published manuscripts are more likely to perform additional research in their future careers.[2],[17] The development and implementation of this tiered team approach aims to both increase research productivity for residents during their years of training while at the same time fosters an interest in academic medicine and trains residents to be research mentors. However, as opposed to less structured means, this method seeks to provide clear and achievable goals for residents to promote maximal research success under the guidance of both near-level peers and faculty mentors.

Collaboration and near-peer mentorships are important keystones of the tiered team approach. Similar core ideals of collaboration, accountability, and team work have been shared by other models which aim to increase research productivity.[18] By building a pyramidal approach to research, residents are able to be involved in multiples aspects of research through various roles. Traditionally, resident involvement in research has taken the longitudinal approach where a resident works on a project from the start to the end with minimal significant contribution from others. While this approach provides a comprehensive research experience and allows residents to participate in research projects with a senior mentor who might share similar interests,[19] the model is inefficient from the productivity standpoint. The tiered team research approach allows residents to participate in multiple roles in various projects simultaneously. For example, resident A could lead a project in which they can serve as the primary author and collaborate with other residents who could assist with various aspects of the project and serve as secondary authors. However, a key component of tiered team research, interconnected network modeling, allows resident A in this scenario to participate in other projects as a secondary author as well. This not only maximizes research productivity for the individual resident but also for the program as a whole.

The success of the tiered team research also rests on the scope of abilities of its research members. Team members each bring their own unique skills, creating a collective team skillset. Team members individual skills complement on another and add expertise to each project?.[20] In addition, with multiple members in each project, each participant further brings with them various methodology and executional experiences that would pave the way for higher rates of success for the project involved.[20] Thus, as the web of interconnected collaboration grows, so does the efficiency and the productivity of the institution’s research.

Participating in research during residency can be a time-consuming affair and may lead to frustration and inefficiencies for residents. Studies have shown that one of the most important factors in predicting future productivity comes from the number of publications produced during residency.[21] In addition, with the changes in duty hour restrictions, residents now have increased time to focus on research.[22] Thus, it is imperative that a good research framework such as that afforded by the tiered team model is implemented to allow residents to maximize their productivity and increase the number of publications during their years of training. Aside from increasing research productivity, concepts such as tiered team research enables near-peer mentorship and stronger collaboration with faculty.

The involvement of a faculty member at the apex of the tiered pyramidal model ensures that there is oversight and guidance provided to the residents during completion of their research projects. Studies have shown that faculty members who have served as research leaders tend to increase the academic activity within the program.[23] In addition, the presence of the faculty member ensures that there is oversight among the research projects and that project timelines are adhered to.

However, this model is not without its limitations. For example, tiered team research is enhanced by the presence of ancillary research staff. While already present at many institutions, the ancillary research staff is key to ensuring that residents are not bogged down with administrative tasks or regulatory requirements and can focus their time on study design and implementation of the study. In addition, a specific limitation of this study involves analyzing the implementation of this model at a single department in a single institution. Nonetheless, the authors strongly believe that the ideas proposed can be generalized to most academic departments to bolster research productivity.

Nonetheless, the tiered team model for research allows institutions and faculty members to modify existing frameworks to significantly increase their research productivity in a predictable and easily replicable fashion.

Tiered team research provides an ideal scaffold that aims to promote collaboration with other residents and staff members who are able to contribute toward each other’s research as well as increase the total number of publications that they are able to participate in.[23] Increasing productivity, as defined by the number of published manuscripts, brings with it advantages to not only the authors in the program but also to the department and institution.[24]

The tiered team approach with its key focus on networking and collaboration for research presents a model that can be implemented at other institutions to both increase research productivity as well as involvement of residents in research. This can, in turn, position team members to be responsive to funding opportunities which can further propel and contribute to the research cycle.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Anonymous. Does research make for better doctors? Lancent 1993;342:1063-4.  Back to cited text no. 4
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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]


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