Resident scholary work in the community hospital setting

T he primary reason to develop the Journal of Community Hospital Internal Medicine Perspectives (www.JCHIMP.org) was to focus on and encourage the scholarly work of faculty and physicians in training (students, residents, and fellows) in community teaching hospitals. Our secondary focus was based on the belief that the presence of quality research is of itself a goal to strive for. Our third focus was to encourage compliance with the stated goals of the Internal Medicine Residency Review Committee regarding residency scholarly work. Let’s start with the latter. The Resident Review Committee (RRC) scholarly activities section reads as follows: Section IV.B.1 ‘The curriculum must advance residents’ knowledge of the basic principles of research.’ Section IV.B.2 also reads: ‘Residents should participate in scholarly activity.’ Section IV.B.3 further states: (1) ‘The sponsoring institution and program should allow adequate educational resources to facilitate resident involvement in scholarly activity.’ Why is scholarly activity a requirement? It is a raised bar that has great merit. Scholarship is considered a major component of good medicine and is the basis of medical intervention and clinical excellence. Scholarship breeds attitudes that benefit trainees. Scholarship enhances faculty development. Scholarship employs scientific discipline. Scholarship requires discipline and attention to detail. Participation in research studies improves accurate observation skills. A major part of scholarship is peer review; the ultimate test of putting your scholarly work under expert scrutiny. Scholarly work emphasizes the evidence-based approach. Many residency programs in the United States are linked to medical schools, often physically in the same location. The mission of many of these institutions is research; and to ensure success, the faculty is recruited and revenues are set aside. Many of these institutions also have long histories affiliated with sponsoring organizations such as the National Institutes of Health and private sector sponsorship. Although scholarship is a RRC requirement, there have been relatively few publications of research curricula for internal medicine residencies. One of the recently published exceptions was the Wake Forest University Baptist Medical Center’s Resident Research Program developed in 2007. The program was published earlier this year (2). Wake Forest has greater than 150 full-time faculty in its department, including dedicated research faculty. They have a long-standing relationship of cooperation with the National Institutes of Health, dedicated physician scientists, and clinical investigators. Their categorical resident program includes a curriculum that has 3 to 5 months of dedicated research, with at least 1 month each year. They also have a chief resident for research and a faculty research director. The program has many faculty research mentors, as well. Outcomes from this program have been excellent. Papers published and presentations nationally and regionally have increased dramatically since 2007. Of course, the necessary funding support is there, although the authors did not offer details. Unfortunately, not all residency programs have access to such wonderful research support, and this particularly applies to community hospitals that make up more than half the sponsored internal medicine programs in the United States. Aside from lack of funding, they have other major obstacles to overcome compared to most university programs.