Dr. Michael B. Rothberg, MD, MPH serves as the Vice Chair for Research in the Medical Institute of the Cleveland Clinic and Director of the Center for Value-Based Care Research. The Center’s researchers use large observational data sets to understand how to best provide high quality, low-cost care to populations of patients. Dr. Rothberg’s research examines quality of care and decision making for common medical conditions, with an emphasis on tailoring treatment to patients based on individual risk and preferences.
In this Spotlight, Dr. Rothberg shares information about a successful research residency program implemented at Baystate Medical Center. Download Dr. Rothberg’s ROCC Star Profile.
Please describe briefly how the Baystate residency research program tackled three of the most frequently cited barriers; lack of interest, lack of time, and insufficient technical support.
Lack of interest comes from competing clinical responsibilities and not understanding what kinds of research residents can do. We began by changing the culture of our program to focus on evidence-based medicine. Once the residents realized how little evidence there was for most of the things they did every day, they became much more interested in conducting original research to guide practice. As residents succeeded in publishing their results, others were inspired to do their own projects.
To address the time issue, we gave residents 3 weeks of protected time in their second year. We also tried to leverage residents’ time by providing a research assistant to perform work that was less educational such as filling out IRB forms or entering data. Instead, we had them focus on study design, data analysis, and writing manuscripts. To help with these tasks, the hospital provided free biostatistical support beginning in the protocol development phase.
Please describe the process by which leadership at Baystate were engaged and supportive of the residency research program?
The research program was part of a larger initiative to improve the overall quality of the residency and attract better residency candidates after a disastrous match. The Chairman of Medicine and the Internal Medicine Program Director were engaged from the very beginning. In fact, the impetus to build the research program came from them. Without the strong support of leadership, nothing would have been possible.
Did you have to focus on faculty development in research before you were able to launch the program? What suggestions do you have for institutions with less capacity to implement a similar program?
Faculty development was a relatively late component of the program. We began by hiring a research director who worked directly with residents on their projects. The key to success was to start small and focus on those residents with the greatest interest and ability and then build on those successes. Later the research director was able to work with residents and clinical faculty together, mentoring both in their respective roles.
How were you successful in gaining support for the allocation of time for residency research over clinical activities?
We took away one elective during the second year and converted it into an ambulatory block. Then we gave the residents 3 weeks of protected time spread over their 3 ambulatory blocks. Because residents on elective do not produce anything clinically, the administration did not object to our removing one elective. Quite the opposite. The net result was to add one week of outpatient clinic, which actually increased the residents’ clinical productivity and hospital revenue.
What role does the Research Director have? What background/qualifications/expertise is critical for this role?
The Research Director runs the entire program. He or she is responsible for teaching the residents how to do research, making sure that every resident has a project, overseeing the support personnel, and working directly with some residents on their projects (usually 3 to 4 residents per year). Ideally, the Research Director also teaches evidence-based medicine and does faculty development. To be successful, the Research Director must be a researcher. Clinician educators without much research experience will generally not succeed in getting residents to do original research, because they cannot act as mentors. Interestingly, most funded researchers would make poor Research Directors.
To successfully compete for external funding requires that researchers focus on a narrow topic area, but few residents will want to conduct research in that area. A good Research Director should have completed a research fellowship and have broad interests, so he or she can work directly with many residents. It’s also critical to know the local resources—what data sets are available, who the other mentors are, how the IRB works, and the general research interests of the other faculty—because Research Directors also have to act as matchmakers, helping residents find appropriate projects in a short period of time. It’s a great part-time job for someone who is coming off a K-award but does not have enough research support. It also takes practice, because resident research has so many constraints. Not only do projects have to go from conception to completion in 2-3 years, but residents have a lot of competing demands and will completely disappear during certain rotations (e.g. ICU). Learning to work around these obstacles is crucial for success. I think it is a career path that is in its infancy, but it can be extremely rewarding for the right person.