Commentary on competency-based medical education and scholarship: creating an active academic culture during residency

Structural

• Does the organizational structure support scholarship? (e.g. Do you have positions for a director of research? A director of education scholarship?)

• Are key faculty members responsible for spearheading scholarship initiatives?

• Is there appropriate administrative, financial, methodological, and statistical support in place?

• How are the faculty members and administrative people organized and coordinated?

• Have research competencies been identified?

• Has a research curriculum been developed?

Human resources

• Do you have individuals with the right expertise available in your department? Are there enough of these experts? Is there a plan in place for retaining and advancing them?

• Do they feel empowered to meet their objectives?

• Do your people have the support (e.g. infrastructure as well as financial, methodological, and statistical support) to meet their goals?

• Have they been provided with sufficient training and time to meet the department’s goals?

Political

• Who holds the power to affect change?

• Who are other stakeholders?

• Who are your supporters?

• Who are your sceptics or critics?

• What conflicts and coalitions exist within your organization?

• Have relationships been developed with other internal (e.g. a research division) and external supporting bodies (e.g. research centres, granting organizations)?

Symbolic

• Is the scholarly mission of the department clear and consistent with its other priorities?

• What symbols (e.g. items/events/people that cause department members to think of the department’s scholarship), stories (e.g. narratives describing key scholars from the department), beliefs, values, and practices are associated with scholarship?

• How is scholarly excellence celebrated?

• Is there alignment between your organization's values and greater social cultural phenomena?

• Are there any competing symbolic issues to which your organization already subscribes? (e.g. Work-life balance; clinical workload)

Structural

• The organizational structure of the department was composed in an ad hoc manner based on the academic physicians who were available.

• Restructure the department to ensure that the academic workload is split equitably.

• Single academics hold multiple positions.

• Reduce the administrative, clinical, and educational workload of researchers in the group.

• The research funding that is available is largely utilized by senior researchers.

• Support a mentorship programme to foster relationships between residents and senior research staff.

• Modify the system for distributing resources to ensure that junior researchers receive monetary support for their projects.

Human resources

• Residents are interested in medical education but there are few faculty trained in this area.

• Recruit faculty with expertise in medical education.

• There are no non-physician researchers associated with the department and very few non-physician collaborators.

• Hire a non-physician research associate to support resident research and/or establish co-mentorship models with other university departments.

• Many of the clinicians hired by the department have no interest in scholarly pursuits.

• Empower junior researchers within the department by supporting their professional development.

• Modify hiring criteria for residents and physician staff to ensure that interests in scholarly pursuits is prioritized.

Political

• The department has few relationships with other parts of the organization.

• Develop a collaborative relationship with the institution’s research groups and other departments.

• The department does not devote a substantive portion of its funds to support scholarly pursuit.

• Consider likely allies and opponents for the proposed changes and meet with them to define and address concerns.

• Few faculty are interested in financially supporting scholarly pursuits.

• Meet with upper administration and request aid and resources for the development of a department that is scholarship-focussed.

• Department leadership is supportive of the goal of increasing scholarship but has not taken concrete action to support it.

Symbolic

• Scholarly achievement is not celebrated.

• Develop rewards and incentives that encourage participation in scholarly pursuits.

• Some group values (e.g. family, clinical care, financial success) can be construed to contradict prioritizing scholarship.

• Bring together members of the department to develop a shared vision and mission statement.

• The residency programme does not have a strong scholarly tradition.

• Prominently feature scholarly successes of department members in appropriate forums. Assist in disseminating research using the institution’s resources.