Increasing Resident Participation in Clinical Research

Jesse M. Ehrenfeld, M.D.
ASA Resident Component Alternate Delegate to AMA

esidency is a unique time in one’s professional career — a period of immense intellectual and personal growth and a time when physicians develop their own practice style. The three to four years that we spend as residents also are a time when there is simply too much material to learn and too little time in which to learn it. Furthermore, as residents, we are constantly faced with difficult choices about which opportunities to pursue during our training, knowing that by choosing one pathway, we will often be excluding another.

Given all of the pressures that residents face and the unique challenges of our field that make leading a balanced life difficult, it not all that surprising that many residents do not pursue research during their clinical training. I would argue, however, that participation in research is paramount to maintaining the vibrancy of our specialty and an important role that must be assumed by all trainees. Conducting research is not only important for the advancement of our specialty but it also is an endeavor that makes us better physicians. Going through the process of learning how to ask research questions makes us better able to critically evaluate the medical literature and is an important skill to acquire.

When asked why they do not participate in research projects, residents often answer either that there is not enough time or that they are simply not interested in research because they do not anticipate an academic career. This is not surprising, given that few programs allow residents protected academic time — unless they have already committed themselves to a full six-month CA-3 research fellowship. Other residents indicate that they do not know where to start or that they are afraid of investing time in a project that might not ultimately succeed. Finally some bluntly assert that they merely want to learn how to administer anesthesia, graduate and go into private practice.

These concerns, whether real or perceived, need not impede one’s participation in research. Although it may seem like a daunting task at first, undertaking a project, particularly a clinical study, has never been easier. This is particularly true given the impact and widespread deployment of automated anesthesia record-keeping systems in many academic centers nationwide. These systems make both retrospective and prospective clinical studies easier to conduct because they can allow one to collect large amounts of data quickly and conveniently. This process can allow a clinically relevant question to be answered without spending inordinate amounts of time collecting data. While the impact of these systems has not yet been fully realized, I expect that they will ultimately shorten the time cycle from hypothesis to result by an order of magnitude.

Besides the use of electronic record keeping systems, how can we make clinical research more accessible and less intimidating to residents? First we must emphasize the importance of participation in this type of activity. We must also do a better job of identifying research mentors who can serve not only as guides to residents who are going through the research process but who are also truly invested in their success. Incentives for research productivity, such as the institution of travel stipends for presentations at national meetings or the creation of protected academic/research time to work on projects, would go a long way toward encouraging this type of activity during residency. Finally we need to change the culture of our specialty — to value not just clinical productivity but also research and, more broadly, education. As more and more programs combine the clinical base year with the three years of anesthesia training, there is a unique opportunity to build in more structured research time across the continuum of training. I hope and suggest that we seize this opportunity, which will benefit our specialty as well as our patients.

Jesse M. Ehrenfeld, M.D., is a CA-2 Resident at Massachusetts General Hospital, Boston, Massachusetts. He is the Resident Component Alternate Delegate to the American Medical Association.