Developmental Behavioral Pediatrics Research Network
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A Survey of Research Training in DBP Fellowship Programs

Background:

 

Although all fellowship programs are required by the Accreditation Council for Graduate Medical Education (ACGME) to have fellows complete a minimum of 12 months of scholarly work and content specifications have been developed to guide training of all fellows, there is little known about the effectiveness of research training for fellows in the field of Developmental Behavioral Pediatrics (DBP).  DBP fellowships are somewhat unique in their focus on interdisciplinary care models as well as study questions which often benefit from qualitative research methodology in addition to more traditional quantitative methods  Many other pediatric subspecialty fellows devote relatively more time to the conduct of research and may focus on one category of research (i.e., basic science research) and other disciplines (such as psychology) require more research training and have more rigorous requirements for demonstrating competence in research skills (graduates of DBP fellowship programs often find themselves competing for federal research grants with faculty in psychology and others with doctoral degrees). Furthermore, as many DBP fellowship programs are funded by the Maternal Child and Health Bureau (MCHB), the importance of including families and patients in developing research questions and designs may be stressed in some programs, but not a particular focus in others.1 

 

There is a paucity of information in the literature regarding training fellows in research methods.  However, the business literature notes that the length of practicing a skill allows refinement and improvements which have been specifically related to developing an expertise2.  ACGME only requires that DBP Fellowship devote a minimum of one year to research training, raising questions about whether this is sufficient to ensure that fellows develop the skills to become an expert in the field of DBP research based solely on time during fellowship training. 

 

Sleight and Reznich3 note that for a curriculum to be effective and implemented, it is important to have a strong advocate for the curricula, a perceived need for the training  by the trainee and the institution, as well as a well articulated plan for implementation of the curriculum.  Barriers noted by these authors included insufficient time for the curriculum and attempting to implement a curriculum that was too large or complex.  When considering the American Board of Pediatrics’ content specifications for topics related to research and scholarly work, there are four main areas, each of which have numerous subheadings:

1)    Ethical considerations in research (such as conflicts of interest and commitment, professionalism and misconduct in research, principles of research with human subjects, principles of consent and assent, vulnerable populations) 

2)    Biostatistics (such as types of variables, distribution of data, hypothesis testing, statistical tests, measurement of association, regression, diagnostic tests, systematic reviews and meta-analysis)

3)    Principles of Epidemiology and Clinical Research Design (such as study types, bias and confounding, causation, incidence and prevalence, screening, decision analysis, cost-benefit, cost-effectiveness, outcomes, sensitivity analysis, and measurement)

4)    Application of Research to Clinical Practice (such as assessment of study design, performance and analysis, assessment of generalizability, application of information for patient care, and effective use of the medical literature)

 

It is therefore apparent that the scope of research topics required for training in DBP fellowship is broad.  A review of core topics for research training was completed by the American Academy of Pediatrics’ Council on Pediatric Research and reported in their policy statement Promoting Education, Mentorship, and Support for Pediatric Research4.  This compilation included a similarly wide range of research topics and areas.  Application of this framework specific to the field of Developmental and Behavioral Pediatrics was described by Schonfeld and Dreyer5.

 

The combination of the relative newness of fellowship accreditation and complexity of the field and vastness of potential study questions and designs ranging from basic science to human behavior compels us to explore the nature of the research training being provided in accredited DBP fellowship programs.  This is important so that we can understand the strengths and barriers of fellowship training in order to maximize the value, quality, and impact of the research training experience.

 

This study is a descriptive survey, aimed at characterizing the content and methodologies used for research training in DBP Fellowship Programs.  Although this study does not propose to be able to answer specific hypotheses, we will attempt to understand the qualities of programs which promote strong fellowship scholarly activity and productivity. 

 

Study Design

 

Target population

 

All ACGME accredited DBP fellowship programs will be invited to participate.  Fellowship directors (or their designee, such as a member of the faculty responsible for research training within the fellowship program) will be asked to complete an on-line survey using Redcap.  The survey will take approximately 45 minutes to complete. 

 

Methods

 

The survey was developed based on review of the literature and review of the American Board of Pediatrics Content Specifications for Scholarly work.  It includes questions that ask about: 

1) program characteristics

2) characteristics of the fellowship program

4) specific methodologies used for such research training (e.g., lectures, mentorship, journal club, etc.) in each of the content areas

5) amount of time devoted to research training

6) resources available to support fellow research activities (including mentors and funding)

7) perceived barriers to providing research training

8) potential solutions to barriers and

9) measures of success of fellow graduates related to research productivity . 

 

The survey will be confidential (not anonymous) in order to allow follow-up by the study team for clarification of results and to allow focused reminders for survey completion.  Results will be reported in aggregate only.

 

This study will be submitted to the Institutional Review Board at Cincinnati Children’s Hospital Medical Center for exempted status.  Completion of the survey will be considered consent for the study.

 

Analysis Plan:

 

Although this study is considered primarily hypothesis generating, we will explore divisional and fellowship factors which may be related to outcome measures of research productivity (including national research presentations, peer reviewed publications, receipt of internal and external research funding, obtaining an academic faculty position upon graduation from the fellowship and receipt of protected research time during this first appointment). 

 

Preliminary Data

 

One of Co-PIs (David J Schonfeld, MD) served as the lead author of a position statement drafted by the Committee on Pediatric Research of the AAP (that was reviewed and supported by many other pediatric academic professional organizations, including the SDBP) about research training for fellowship programs that included a description of the scope of research training recommended across the fellowship programs.  As part of the process of developing this position statement, it became clear that concerns about the ability to provide sufficient training in research for clinical fellowship programs was common across many other pediatric subspecialties.  The recommended research curriculum components was incorporated into a chapter by Schonfeld and Dreyer5 which helped serve as the basis for the design of the survey.

 

Potential Impact:

 

Information from this survey can inform Fellowship Directors on approaches used to train DBP Fellows in research across the accredited fellowship programs.  Individual Fellowship Programs can use this to identify gaps and resources in their own training programs; resources for meeting some of these gaps could be shared across programs.  Common barriers and any common concerns about the adequacy of research training may be used to inform policy for research training for agencies (e.g., MCHB, ACGME) and professional organizations (e.g., SDBP, Pediatric Academic Societies) to improve the research education of Fellows and expand the research efforts of the field of developmental-behavioral pediatrics.

 

Timeline:

The study will take approximately 1 year to complete.  This will include IRB submission for exemption.  The survey will be put into Redcap and sent to DBP fellowship directors.  E mail reminders will occur every 2 weeks to improve participation rates. 

 

Activity

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

IRB

X

 

 

 

Survey upload

X

 

 

 

Survey completion

 

X

 

 

Data analysis

 

 

X

 

Reporting and writing results

 

 

 

X

 

References:

1. Research: Cultural and Linguistic Competence Checklist for MCH Training Programs  National Center for Cultural Competence Georgetown University Center for Child and Human Development  available for download at: www.gucchdgeorgetown.net/NCCC/training/ 

2. Ericsson KA, Prietula MJ, Cokely ET. The making of an expert. Harv Bus Rev. 2007 Jul-Aug;85(7-8):114-21, 193.

3. Sleight DA, Reznich CB  Implementation of curriculum by family medicine fellows: what factors help and what factors hinder?  Fam Med. 2006 Apr;38(4):270-4.

4.  American Academy of Pediatrics Committee on Pediatric Research.  Promoting Education, Mentorship and Support for Pediatric Research.  Pediatrics 2001:107;1447-1450.

5. Schonfeld, DJ, Dreyer, B.  Research Foundations, Methods, and Issues in Developmental-Behavioral Pediatrics in In Wolraich M, Dworkin P, Drotar D, Perrin E:  Developmental – Behavioral Pediatrics: Evidence and Practice.  Philadelphia:  Elsevier Mosby, 2008, pp. 47-56.