Research Literacy: Core Element in a Physician's Development?

Abstract

The educational journey of a physician involves a long and intensive path beginning with a basic science curriculum and then building in clinical experiences. The ultimate goal is to develop research-literate physicians who can skillfully navigate the incredible amount of medical information that exists to make well-informed clinical decisions in the best interest of their patients. In this grounded theory study, five (5) Chief Residents (or recently graduated residents) were interviewed regarding their residency training experience and seventeen (17) medical professionals who were identified as Residency Program Directors and/or Planners were interviewed to gather their insights related to the development of research-related skills during a physician’s training. While not all physicians conduct research, all physicians are required to be skilled consumers of research and for that reason, specific attention was paid in this study to the development of overall research literacy skills. This study highlighted the fact that, as is true for any educational endeavor, there are important structural elements that provide a framework for a learner’s journey (e.g., curriculum, regulatory and/or accreditation program requirements, etc.). In addition, there are critical motivational factors, such as self-directed learning and commitment to lifelong learning, which drive the direction and depth to which a learner explores that curriculum. The study identified the following three inter-connected themes (structural elements, curricular directions or guides, and motivational factors) regarding physicians’ development of research literacy skills: Theme 1: The regulatory/accreditation systems establish the base level expectations for each of the competencies required of learners across the medical education continuum, however, there is wide variability in how those requirements are interpreted and incorporated into each medical school’s curriculum. Furthermore, the metrics used do not always align with the skills required to successfully perform Evidence-based Practice (EBP). (For example, the base level expectations related to research and scholarly activities do not necessarily assess the research and literacy knowledge and skills necessary for physicians.) Theme 2: The influx of medical information has heightened the need for physicians and patients to be discerning consumers of research and medical information. There is wide variability in the level of proficiency a physician achieves during their training with respect to research literacy (driven, in part, by personal interest, pursuit of available opportunities and resources, and the demands of the physician’s life, role, and institution), although now, more than ever, all physicians must develop and maintain those basic skills to be able to make well-informed clinical decisions. Theme 3: The ability of a physician to meet the demands of the public to deliver EBP which leads to quality patient care (i.e., provide safe, effective, patient-centered, timely, efficient, and equitable care) is highly-dependent upon their commitment to self-directed, lifelong learning which facilitates the acquisition and maintenance of research literacy skills and enables them to be a discerning consumer of medical information. In this dissertation, I will discuss the following themes which were revealed in my studies related to: organizational structures (accreditation and regulatory oversight); curricular guidance; and the importance of individual learners’ commitment to self-directed lifelong learning. Each theme will be examined to determine the role it plays in developing a research-literate physician. I will offer some perspective on steps that could be taken to address concerns, and offer recommendations for making progress as we move forward. The implications for practice include: accelerating the adoption of updated accreditation requirements that relate to research and scholarship; identifying opportunities for collaboration across the continuum; developing meaningful metrics to track progress; highlighting the value of health sciences library services as it relates to research literacy; training HCPs to be more aware of the power and/or limitations of the evidence; stressing the importance of personal commitment to lifelong learning and acknowledging the role of the learning environment in guiding the learners’ development journey. After describing the implications and the impact each has on the practice of medicine, I will then recommend one coherent theory which incorporates all of those factors. The dissertation concludes with limitations of the study and opportunities for further research which promote more direct links to patient outcomes. Keywords: physician development, research skill development, research-literacy, self-directed learning, lifelong learning, grounded theory