Scholars and Collaborators on the Frontline: Resident-led Research in a Prospective, Observational Study in Critically Ill Patients
CCCF ePoster library. Ulic D. Oct 27, 2015; 117362; P95 Disclosure(s): PSI Grant HHS NIF Fund Grant
Dr. Diana Ulic
Dr. Diana Ulic
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Abstract
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P95


Topic: Education Science


Scholars and Collaborators on the Frontline: Resident-led Research in a Prospective, Observational Study in Critically Ill Patients



Diana Ulic, K. Honarmand, E. Belley-Cote, A. Khalifa, A. Gibson, G. McClure, F. D'Aragon, F. Alshamsi, B. Rochwerg, E. Duan, T. Karachi, R. Whitlock, D. Cook

Department of Medicine, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada | Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada | Anesthesiology, McMaster University, Hamilton, Canada | Faculty of Health Sciences, McMaster University, Hamilton, Canada | Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada | Anesthesiology, McMaster University, Hamilton, Canada | Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada | Anesthesiology, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada | Surgery, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada

Introduction:

Conducting clinical research represents an important academic opportunity and a training program expectation during residency. Engaging in research encompasses all seven CanMEDS roles, and is aimed at fostering life-long critical appraisal skills through first-hand experience of research methodology. Although residents are usually highly involved in study design and data interpretation, they are rarely involved in all stages of a study. Highlighting the CanMEDS roles of 'Collaborator' and 'Scholar', our objective is to describe a novel, resident-driven approach to clinical research in a multicenter prospective pilot observational study.




Objectives: The purpose of this study was to apply the CanMEDS framework to the conception and implementation of a novel educational model for resident research. We aimed to engage residents in intense, collaborative work at all stages of a study to foster a better understanding of research methodology as well as to cultivate ongoing engagement in research initiatives by encouraging ownership over a study.



Methods:

Over ten months, seven residents collaborated on the PROTROPICS Pilot Study, which aimed to evaluate the feasibility of a larger study to assess the prognostic importance of troponin elevations in critically ill patients. Full resident involvement occurred across multiple stages of the study. As Principal Investigator, a research fellow completed the literature review and initial protocol. Prior to study implementation, residents collaborated together on the creation and piloting of case report forms, assessment of inter-rater reliability for data collection, and ethical training for obtaining valid research consent. During the study implementation period, residents ensured full coverage of all participating ICUs for data collection, and were responsible for organization of data, clear documentation of the consent process, and the discussion and resolution of ethical and logistical setbacks with other resident collaborators. Finally, residents collaborated in the post-study period to complete data entry, rigorous follow-up on incomplete data and consent questions, and ECG adjudication as well as result interpretation.




Results:

During the 1-month recruitment and 4-month follow-up in three Hamilton ICUs, resident-investigators worked daily, outside their clinical duties, screening 304 patient admissions (representing 280 eligible patients), procuring deferred consent for 213 patients, collecting and entering patient-level data. This generated 1134 daily forms for data entry and interpretation. Consistent, longitudinal involvement resulted in a deeper understanding of research methodology and research ethics than usual for resident research, and facilitated early identification and resolution of barriers to recruitment.



Conclusion:

High-intensity resident-led research was possible for the PROTROPICS Pilot Study. The 'Collaborator' role was developed through interaction of resident-investigators with one another in dividing study responsibilities across sites, and with ICU staff while in-servicing and addressing study concerns. The 'Scholar' role was developed through hands-on experience in research methodology. Immersion of residents in so many aspects of this study fostered project ownership, represented unique experiential research education, and encouraged academic leadership. This model was feasible given the study's short, well-defined timeline that allowed for high-intensity work on the part of the resident collaborators even alongside clinical duties. This resident-led model could serve as an educational framework for motivated residents during a well-circumscribed research academic block, and in this capacity, would fit well into a competency-based research curriculum.



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