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Journal publication requirement, an edge to medical residency program

Before joining Baylor Scott & White Health, Baylor University Medical Center at Dallas resident Philip Edmundson, MD, had limited exposure to the world of research.

“I was a philosophy major in undergrad, so I didn’t do any research as an undergraduate,” said Dr. Edmundson, a third-year post-graduate resident from the University of Texas Southwestern Medical School. “I didn’t do any research in medical research, so I’m pretty new to the game.”

In just three years, Dr. Edmundson has found himself on the investigative fast track, having contributed to multiple studies, posters and papers on Baylor University Medical Center’s trauma team. Among them: research related to predicting frailty in trauma patients, trauma activation criteria, ICU consent practices and anticoagulants (blood-thinners).

Much of this research has been possible by good timing. Dr. Edmundson’s residency coincided with the start of Baylor University Medical Center’s resident-research program, which has since 2013 required surgery residents to publish at least one manuscript in a national journal.

James Fleshman, MD, chairman of the department of surgery at Baylor University Medical Center at Dallas, emphatically encourages this requirement among Baylor University Medical Center’s pool of 45 surgical residents.

“There’s always been research done here, but it’s usually done by attending physicians and others,” said Dr. Fleshman, who helped spearhead the program three years ago. “We wanted to involve residents so they’d have the tools and skills to launch their own projects.”

Critical thinking resources to fuel research

In the three years since the program’s inception, resident-driven research has increased significantly, and Baylor University Medical Center’s department of surgery has kept pace by offering special resources to support new and ongoing projects. Among them: several research coordinators and interns, a peer-review committee for surgical research, a statistician, a manuscript-writing resource and a structured template that helps residents organize protocols into standardized article formats.

All told, these resources help reduce the time and stress imposed on the already busy residents.

“The support has been tremendous,” Dr. Edmundson said. “They can be working while I’m doing the 80-hour a week residency thing, and we’re able to get work done very quickly because of it.”

The process encourages ideation, strategic thinking and potentially fosters interests in research topics that go well beyond the five-year residency.

Dr. Fleshman adds that the process encourages ideation, strategic thinking and potentially fosters interests in research topics that go well beyond the five-year residency. And by the end, they not only have a published manuscript on their curriculum vitae, they’ve also learned critical thinking skills to discern which research applies to their clinical cases.

“We want to make residents in surgery understand the impact of research on their practice and on their career,” Dr. Fleshman said. “But the other benefit is when they read an article that relates to a particular patient, they have to be able to understand whether or not it’s actually relevant and applicable—and whether they can trust the conclusions.”

The importance of mentor collaboration

Manuscript construction and data collection aside, one of the most important resources Baylor University Medical Center offers to residents doing research is established mentors. Dr. Fleshman is one of them.

“If a resident has a project with me, we talk about the hypothesis and study design, then they take the first stab at writing it, followed by a series of discussions and revisions to improve it,” he said. “When the data is done and we receive it back from the statistician, we sit and discuss the results, which conclusions we can draw, and what’s interesting but unable to be stated as a definite outcome as a study.”

That’s when the first draft takes shape — following the standard background/intro/methods/results/discussion/conclusion flow. Dr. Fleshman works in tandem with his residents during this part, helping refine and revise along the way. But mostly, he stresses that he’s only there as a guide.

“They do most of the work and most of the thinking under my direction,” he said. And eventually, if accepted, they’re presenting at major conferences and meetings, too.

Ongoing education from an established staff

Additional support comes in the form of an established staff who helps residents navigate research questions. Among them: Kim Monden, PhD, director of surgical education and research at Baylor University Medical Center at Dallas, who has been developing protocols for studying resident education, including one study related to delivering bad news. Other staff resources include Ganesh Sankarayanan, PhD, research director for simulation at Baylor University Medical Center at Dallas, and Peter Kim, MD, associate program director for research at Baylor University Medical Center at Dallas.

These folks help lead monthly research education sessions so residents understand the mechanics of hypothesis creation, research planning, statistical analysis and participation pools.

“It’s really nice to go to these meetings and hear what everybody else is working on, because I’ve realized that a lot of the questions they’re answering are similar to questions I have,” Dr. Edmundson said. “So I started asking my own questions. Being able to use research as an avenue to improve our quality process and our patient care when you encounter situations that don’t quite make sense has been valuable for me.”

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The future of resident research

In the time since resident research became a requirement, projects have ranged in everything from Dr. Edmundson’s trauma work to studies on rectal cancer, cardiac surgery (LVAD and ECMO) and endocrinology, plus a handful of National Surgical Quality Improvement Projects (NSQIP), among others.

And that’s just in three years. Further down the line, Dr. Fleshman’s goal is simple: to have a robust, resident-driven research program.

“I would anticipate that every resident would publish one paper every year,” he said.

Baylor Scott & White Health’s dedication to hands-on medical education is preparing future generations of clinicians throughout the state of Texas.

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Journal publication requirement, an edge to medical residency program