The findings of this study revealed varying levels of satisfaction with and perceived outcomes of mandatory scholarly projects, and that trainees felt that luck played a significant role in accessing crucial enablers such as protected time, quality supervision, and accommodating institutional structures.
Trainees’ reliance on serendipity for obtaining such support is problematic, as their absence is likely to lead to an unsuccessful and negative research experience, and less meaningful research outputs. Negative experiences with mandatory research projects are not uncommon, with previous research showing that trainee satisfaction with mandatory scholarly projects is highly variable.(11, 14, 16, 46) Quantitative research has found results similar to our study- that trainee satisfaction is impacted by poor quality of supervision, inappropriately scoped projects, lack of organisational support, and frustration with prohibitive “hoop jumping” type requirements.(13, 17, 47) Furthermore, trainees have identified mandatory projects as a source of stress and a negative impact on work-life balance.(48) Our research found that some trainees who had access to supports did have highly positive experiences, while others felt, in hindsight, that the experience was valuable despite challenges during the project, especially if they pursued a research career or produced meaningful research outputs.(49) However, this variability in experiences is vital to address, as negative experiences may have the opposite of the intended curriculum goals by discouraging future engagement in research.(14, 34) It would be considered a major failure if development of clinical competencies was left to chance, rather than a result of an intentionally structured and resourced training curriculum. As research competencies are a required component of the curriculum, their development should receive similar consideration from colleges.
Our recommendations are twofold. Firstly, we recommend a well-supported pathway for trainees to pursue research projects voluntarily, requiring enabling supports to be embedded in both the colleges and the health services trainees are placed within. It can be argued that it is unfair to expect research-naïve trainees to have success in environments that do not have structural support available. Even the more research-experienced trainees in our study reported that they anticipated a lack of supports and intentionally limited their project scope, thereby curtailing their potential contributions and engendering a missed opportunity for further skill development. The literature affirms many training programs do not have key elements shown to support trainee research activity, such as an organized research curriculum, appropriate supervision and protected time.(33, 47, 50–53) A trainees’ experience should not rely on where they are placed, especially when current systems may disadvantage those placed in under-resourced regional/rural locations or smaller health services.(16, 54)
Supports should be directed to the subset of trainees who choose to complete a project, rather than providing this significant level of support to every trainee. Firstly, it is likely impractical, both in terms of limited funding available for such activities, and because of a paucity of skilled research supervisors.(5, 30) The current system compounds this issue, as trainees who feel their training has not furnished them with the necessary research skills are nonetheless compelled to supervise the mandatory projects of future trainees, potentially passing on suboptimal research practices. As a minimum, any research-naïve trainee should have access to both content and methods expertise, which may require dual supervision. Secondly, studies have shown that supports may be better directed to health professionals with higher intrinsic motivation to do research, as they are more likely to be successful than those with only an extrinsic motivator in the form of meeting training requirements.(11, 55, 56) Some colleges, such as the RACGP,(57) have recognized the need for institutional supports for those few wishing to pursue a clinician researcher career and provided a specialised pathway, including protected time. Few doctors currently identify as clinician researchers,(58) and there are concerns this number is declining.(59) For most trainees, the value of mandatory trainee-led projects for clinically-orientated careers, and for adding meaningfully to the evidence base, is questionable. We posit that the limited resources available for research should be funnelled into high quality supports for research-interested trainees, and increasing the number of clinician researchers.
Our second recommendation is for colleges to value and incentivise forms of research engagement other than leading a project for the remainder of trainees. It is important for research interpretation and application to remain an expected competency for all trainees, but we have found a mismatch between the intended goals of scholarly projects and the realized outcomes. If the key goal of specialty training research requirements is to produce clinicians informed in research methodology, then more emphasis should be placed on appraising and implementing research, and on participating in, rather than leading, research. Options other than mandatory research projects may be more effective and far less resource intensive in imparting the necessary skills. Key theories of research culture and behaviour change hold that mandating activity should be the last strategy implemented, after other strategies have made it possible, easy, normative and rewarding.(60) Studies support this, finding that even mandating trainee research activity has mixed impacts on trainee outputs,(11, 18, 50) and that trainees often feel that research projects should not be a mandatory part of training, preferring it be replaced with other activities.(14, 16, 18, 46, 48) However, many trainees also emphasise the importance of understanding the principles of research and evidence for training, (16, 18, 30, 46, 48) and recognise that trainee-led research outputs are vital to career progression in many specialties.(14, 16) Thus, research skills must remain an expected competency for trainees, and each college must consider the individual barriers and benefits to various research training options specific to their context.
The literature points to some alternate options for trainees to gain research competencies. The Australasian College for Emergency Medicine replaced their mandatory scholarly project with a choice of a coursework or project pathway in 2009, due to perceptions of research waste and limited value to training.(17) Subsequent research comparing the two pathways found trainees rated the coursework pathway as more useful in achieving all learning objectives.(17) More recently, the Royal Australasian College of Surgeons has adjusted its general surgery training criteria to have less focus on leading a scholarly project, and to better recognise other types of research activities and prior learning,(61) although formal evaluation is yet to occur. Participation in large student and trainee-led research collaboratives could also be recognised activities in college curricula. These collaboratives have been shown to not only produce high quality and impactful research, but are also effective in developing research competencies and promoting the long term research engagement of clinicians.(62–65) Such avenues for trainees to participate in, but not lead, research projects should be supported, in order to provide trainees without a preconceived research interest an opportunity to develop this interest. To support a sustainable cultural shift, changes also need to be considered up- and down-stream from residency, including processes that disincentivise the research “arms race” by refocusing evaluation of research activity at key career transitions on quality and competency, rather than quantity.(66)
Underlying potential changes to research requirements should be a clear and agreed upon understanding of the research competencies expected of trainees, and, accordingly, specialist doctors. Future research should focus on identifying a set of core research-related competencies that are relevant to all graduating trainees (67), and supporting colleges to develop and implement new curricula. Competencies for those completing a research project should also be clarified, acknowledging that the goal is to impart basic research skills, and that it is not possible or necessary to impart all the skills required to consistently produce high quality research after a single small-scale project.(68)
This study has two key strengths. First was the use of qualitative methodology which allowed for in-depth exploration of trainees’ experiences and perceptions. Second was the inclusion of doctors from multiple medical colleges, which added to the diversity of perspectives and experiences represented in this study. The study also had limitations. Our participants may have provided a more supportive narrative of mandatory research compared to the general trainee population; indeed many stated they felt their experiences were more positive than those of their colleagues. As noted earlier, participants recruited from the survey reported generally higher levels of satisfaction with, and support of, mandatory research projects than other survey respondents.(30) The study only included trainees from Australia and New Zealand, which limits the transferability of the findings to other countries and contexts. Finally, the important views of those who support scholarly projects, including supervisors, leadership and research support staff, were absent.