Restructuring the Residency Research Experience 

By:  Sara Catherine S. Pearson, PharmD, BCPS and Michael P. Veve, PharmD, MPH 

Publish or Perish? 

If this statement were true, the majority of pharmacy residents would perish. Despite the large number of pharmacy residents involved in longitudinal research projects annually, only a minor percentage of these projects are published.¹ Several previously identified barriers include limited research guidance from preceptors, poor preceptor engagement and/or incentivization, incorrect study design, and access to research resources.^{1, 2, 3}

ASHP Goal R2.2 for PGY-1 residency programs states that residents should be able to “demonstrate ability to evaluate and investigate practice, review data, and assimilate scientific evidence to improve patient care and/or the medication-use system.” Objectives that meet this goal are: identifying, implementing, and assessing changes in the medication use system and presenting the final results of the project orally and in writing. At face value, these objectives can be achieved by having residents complete a research project and present their findings. But, if we expect residents to “evaluate and investigate practice, review data, and assimilate scientific evidence,” we must scaffold this learning. 

To facilitate achieving residency research learning goals, we propose a structured, longitudinal research learning curriculum to be integrated into the PGY-1/2 research learning experience (Figure 1). The goal of this program is to provide a research framework to empower pharmacy residents, and also preceptors, with the skills needed to be successful researchers post-PGY-1/2 residency.

Figure 1. Proposed longitudinal research learning curriculum and timeline.

We have summarized some of the challenges previously mentioned and provided suggested solutions where applicable. 

Topic Selection

Many preceptors and residents struggle with identifying a meaningful research question (“Where do I start?”). Successful research questions commonly evolve from brainstorming sessions focused on areas lacking clinical evidence, or even pet-peeves in clinical practice.  Completing these exercises with a group of supportive peers can ensure generation of more successful project ideas. It could be argued that incoming PGY-1 residents lack an idea of the critical issues and priorities at their institution, and research ideas and content generation is better suited to preceptors. Research ideas should also be vetted using FINER criteria (Feasible, Interesting, Novel, Ethical, Relevant),⁵ with specific, measurable objectives that are directly applicable to addressing the institution’s or department’s goals. Prospective studies should rarely be considered as PGY-1/2 research given the significant time investment needed to yield successful results. Preceptors should consider the high rate of failure over the attempt to make their resident’s project “stand out from the crowd”. 

Study Design and Sample Size Calculations

The most common longitudinal research project study designs include retrospective cohorts, cross-sectional studies (i.e., medication use evaluations), and case-control studies. However, a common barrier to successful research is selecting the appropriate study design needed to answer the research question.^{1, 2} Preceptor unfamiliarity with study design intricacies, including sample size calculations, can often lead to inconclusive study findings (i.e., Type-II error) and abandonment of the project.² Sample size considerations should include an effect size based on prior or similarly-related research findings, but also be realistic/reflective of the research study site population; free web-based sample size calculators or software is available on the internet. Pharmacist researchers should consult with internal or external resources (see below) in reference to appropriate study design selection and sample size calculations to mitigate statistical issues. 

General Pharmacist Research Support

This is a nebulous, but necessary category to highlight. The overarching idea of continued research support can include creating incentives and dedicated time to engage PGY-1/2 preceptors, providing access to expensive statistical software such as SPSS, meeting and travel support to present abstract findings at national meetings, manuscript writing and preparation, and support for publication and/or open access processing fees. Without having a plan in place for this support, publishing research becomes more difficult. There are several educational resources, with associated costs, targeted to research and study design available through different pharmacy organizations:

ASHP Resource Research Center: ASHP has developed content focused on designing and research. These include pharmacy research methods papers and the “Essentials of Practice-Based Research for Pharmacists” web-based activities available for purchase. 

ACCP: MeRIT (Mentored Research Investigator Training) programs. The MeRit program is focused on mentored research training over two years, targeted towards research inexperienced individuals.  

A structured research curriculum can enhance the PGY-1/2 experience and empower trainees to continue successful research in clinical practice. Initial steps towards successfully implementing pharmacy research culture change include obtaining department of pharmacy leadership buy-in, providing consistent guidance to residents, and addressing common research barriers. Suggested metrics for success could include research abstract presentations at national conferences; metrics may eventually mature into publication rates. However, it is important that initial research expectations be tempered to allow for small improvements to the structured research program over time. 

Will you elevate your learner’s research endeavors, or continue the status quo?

References:

1. Weathers T, Ercek K, Unni EJ. PGY1 resident research projects: Publication rates, project completion policies, perceived values, and barriers. Curr Pharm Teach Learn. 2019 Jun;11(6):547-556. 

2. Bauman JL, Jackevicius C, Zillich AJ, Parker RB, Phillips BB. On the methodology of retrospective chart reviews. J Am Coll Clin Pharm. 2019;2: 6-7.

3. Irwin AN, Olson KL, Joline BR, Witt DM, Patel RJ. Challenges to publishing pharmacy resident research projects from the perspectives of residency program directors and residents. Pharm Pract (Granada). 2013 Jul;11(3):166-72.

4. Required competency areas, goals, and objectives for postgraduate year one PGY1) pharmacy residencies.  Bethesda, MD: ASHP; 2015. 

5. Farrugia P, Petrisor BA, Farrokhyar F, Bhandari M. Practical tips for surgical research: Research questions, hypotheses and objectives. Can J Surg. 2010;53(4):278-281.

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Pulses is a scholarly blog supported by a team of pharmacy education scholars