Integrating Scholarly Activity into Residency Training

The Family Medicine Update from the Association of Family Practice Residency Directors (AFPRD) on integrating scholarly activity into residency training(1) is timely and provides an example of how a residency program can combine writing evidence-based reviews and quality improvement activities to meet scholarly effort needs without instructing all residents in basic research. This is especially important as the Accreditation Council for Graduate Medical Education (ACGME) requires that residency programs demonstrate they are assessing competencies in this area, and practical considerations mean that residency programs must seek solutions that can fit within existing program budgets and schedules.

DynaMed would like to freely offer tools that residency programs can use to teach and assess competencies in practice-based learning and improvement. DynaMed is an evidence-based medical reference, and the peer review process for DynaMed has been found to be practical and educational for use by residency programs in meeting scholarly effort needs. In helping with this process, DynaMed has developed support tools which include the following:

1) Answering Clinical Questions Resident Assignment Sheet. This is a two-page form which can be used by a resident to record a clinical question that occurs during practice, the sources searched and time spent to find an answer, the answer found including the type of evidence, how the answer was applied to patient care, and what was learned. The faculty can then record whether four ideals were met (documenting the competency), or what action steps were taken if ideals were not meant (documenting competency for managing information and supporting education).

2) Critical Appraisal Support System. This is an interactive web site to support critical appraisal, derived from the methods of the Evidence-Based Medicine Working Group(2) and worksheets from Information Mastery courses taught by Slawson and Shaughnessey. Users can answer critical appraisal questions step by step for seven different types of articles, and the final summarization can be printed or copied (e.g. for a resident’s portfolio).

3) Practice-Based Learning Competency Tracker. This is a one-page form which can be used to track the progress through selecting a clinical topic, performing critical appraisals of selected articles, reviewing an evidence-based summary, selecting evidence-based quality indicators, conducting a chart review, creating an action plan, and presenting the results.

These support tools can be used uniquely and separately, or combined with the opportunity to review and author evidence-based topic summaries for DynaMed. Regardless of whether residency programs choose to subscribe to or collaborate with DynaMed with respect to our clinical reference content, we are willing to offer these tools for use in residency programs, and would like to improve these tools based on the experiences of programs who implement them.

You can find these tools at http://www.dynamicmedical.com, currently listed under the Residency Programs link.

Sincerely,

Brian S. Alper MD, MSPH; Medical Director, DynaMed www.dynamicmedical.com; Research Assistant Professor, University of Missouri-Columbia Department of Family and Community Medicine

Brian A. Selius, DO; Associate Director, St. Elizabeth Family Medicine Residency; Associate Editor, DynaMed www.dynamicmedical.com

1. Carek PJ for Association of Family Practice Residency Directors. Integrating scholarly activity into residency training. Ann Fam Med 2004;2:87-88.

2. Centre for Health Evidence. User’s Guides to Evidence-Based Practice. http://www.cche.net/usersguides/main.asp Accessed February 16, 2004.

Competing interests:   Brian S Alper MD, MSPH is a principal in DynaMed LLC which publishes DynaMed. Brian A. Selius, DO is a DynaMed Editor but does not have a financial competing interest.