Cultivating change: Engaging residents in research.

BACKGROUND: The American Council of Graduate Medical Education (ACGME) guidelines for scholarly activities by family medicine residents require at least one activity per resident and encourage conference presentations. Meeting these guidelines has traditionally been challenging due to a multitude of factors from lack of time to limited administrative support. Studies have shown that resident participation in research was associated with higher levels of satisfaction with training. We aimed to develop and evaluate the effectiveness of a dedicated research curriculum in achieving ACGME goals for our residents. METHODS: We performed a need assessment that identified strengths and obstacles related to research which then guided the actions taken to build the curriculum. Revised curricular elements included a research focused lecture series, a restructured journal club, financial support for presentations and project expenses, a specific timeline for project completion, and the development of a regional research day involving multiple family medicine programs. Dedicated research time was built into the resident schedule and presentations at local, regional and national conferences were encouraged and supported. RESULTS: Following implementation of the curriculum there was a marked increase in the number of scholarly projects performed by residents. Prior to implementation there had only been one presentation at a national conference in the previous five years. This increased to an average of four presentations per year in the following five year period. On a regional scale, the initial success of the local research day led to a continued expansion and now includes six family medicine programs. CONCLUSION: Implementation of a dedicated multifaceted research curriculum significantly increased the participation of our residents in scholarly activities and led to a near five-fold increase in presentations at regional and national levels. Additionally, resident satisfaction in scholarly activities increased and a far greater number of graduating residents went on to complete fellowships.

2002 ACC/AHA guideline versus clinician judgment as diagnostic tests for chest pain.

PURPOSE: Hospital admissions for chest pain are frequent and costly. The use of objective criteria to determine the need for hospitalization may save money. Here we compare the 2002 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with unstable angina and nonST-segment elevation myocardial infarction to clinical judgment as diagnostic tests to predict which patients with chest pain will develop positive cardiac troponin-I. METHODS: Researchers conducted a retrospective chart review of patients admitted to a military community hospital for chest pain over a 2-year period. The study determined sensitivity and specificity for both the ACC/AHA guidelines and consensus of clinical judgment to predict which subjects would develop positive cardiac troponin-I. RESULTS: Positive cardiac troponin-I was very low (7 of 386). Both the ACC/AHA guidelines and clinical judgment had sensitivities of 100% (95% CI, 65-100) to predict positive cardiac troponin-I. The ACC/AHA guideline was 13% specific (95% CI, 12-13), with clinical judgment at 48% (95% CI, 47-48). Classification as low risk had a high negative predictive value (ACC/AHA guideline, 1.00 [95% CI, 0.95-1.00]; clinical judgment, 1.00 [95% CI, 0.99-1.00]). CONCLUSION: Patients categorized as low risk by either method could probably be discharged from the emergency department without developing positive troponin-I.