- Citado por SciELO
versión impresa ISSN 1130-0108
Rev. esp. enferm. dig. v.96 n.10 Madrid oct. 2004
Research training during medical residency (MIR). Satisfaction questionnaire
A. Ríos Zambudio, F. Sánchez Gascón, L. González Moro and M. Guerrero Fernández
Department of General and Digestive Surgery. Comisión de Docencia. University Hospital Virgen de la Arrixaca. El Palmar. Murcia. Spain
Introduction: it is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training.
Materials and methods: the aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178).
Results: as far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the influence that these variables may have on the general satisfaction of residents with his or her residency, these variables are seen to be significant factors of dissatisfaction.
Conclusions: most residents are dissatisfied with their scientific training and have relatively few facilities for developing such skills, which in turn results in a scarce number of scientific studies and doctoral theses.
Key words: Internal residents. Scientific training. Satisfaction. Thesis. Publications.
Ríos Zambudio A, Sánchez Gascón F, González Moro L, Guerrero Fernández M. Research training during medical residency (MIR). Satisfaction questionnaire. Rev Esp Enferm Dig 2004; 96: 695-704.
Correspondencia: Antonio Ríos Zambudio. Avda. de la Libertad, 208, Casillas. 30007 Murcia. Fax: 968 369 716. e-mail: ARZRIOS@teleline.es
It is widely recognized that the training received from the specialist medical training program through the residency system (MIR system) is highly rated and has improved the quality of health care in hospitals (1-3), although there is room for improvement in selected areas (3-10). It is during this postgraduate period of specialization that a doctor's knowledge improves quickly; thus, this period should be made use of as much as possible for the benefit of both doctors and the health system in general (4).
It should be taken into account that it is during this training period that knowledge, skills and habits are acquired in all aspects (clinical, educational, investigational, and ethical), which will mark the doctor's professional future. In this sense, residents who do not acquire the habits and knowledge necessary for carrying out research activities will probably not undertake such activities in the future. Therefore, it is essential that those responsible for teaching residents (MIRs) encourage such activities, in order to train effective residents with effective clinical, scientific, investigative, educational and ethical bases. What is more, it is important to know the current situation of residents with respect to their research training and how they evaluate it.
The objective of this study is to analyze the level of satisfaction of internal residents in our hospital with respect to their scientific and research training, as well as to determine deficiencies in their training.
MATERIALS AND METHODS
The study was carried out in a third-grade hospital accredited for graduate and postgraduate teaching. A questionnaire was designed (15 multiple-choice questions) to evaluate the satisfaction of residents (MIRs) with their scientific and investigative training during the residency period. In the evaluation questions a scale of discrete continuous variables was used (from 0 to 10), which were then grouped into five categories: 0-2 very unsatisfactory; 3-4 dissatisfied; 5-6 normal or indifferent; 7-8 satisfied; and 9-10 very satisfied.
Questionnaires were usually distributed by internal mail during February and March 2002 to all MIRs registered in our hospital at that time. The questionnaire was anonymous and self-directed. It was placed in a sealed envelope and handed in to the secretary of education in our hospital. Of 237 residents, those who were on secondment in other hospitals (service commission) at the time of questionnaire administration were excluded (n = 10), the questionnaire being distributed to 227, with 178 (78%) answering. Three were excluded for being handed in blank, with 175 valid questionnaires (77%). There was a slight predominance of women in the survey (n = 98; 56%), and the average age was 27 ± 7 years (24-45 years). With respect to the main specialist group, 47% (n = 82) were medical specialists, 22% (n = 38) were surgical specialists, and 31% (n = 54) were in central services; in the remaining case (0.6%) the speciality was not specified. When considering year of residency, 22% (n = 39) were residents in the first year, 25% (n = 44) in the second year, 26% (n = 46) in the third, 20% (n = 34) in the fourth, and 5% (n = 8) in the fifth year; in the remaining 4 cases the year of residency was not stated.
Variables analyzed included personal characteristics (age, sex, year of residency, and specialist area), presence of departmental sessions (emergencies, clinical, bibliographical, and morbidity/mortality), an evaluation of the different types of training received by residents (MIRs) (health care, educational, investigative, and ethical), facilities for undertaking scientific activities, facilities for attending courses and congresses, scientific work published, and current doctorate status (thesis already written, thesis topic, doctorate courses, or neither courses nor thesis).
Some descriptive statistics were calculated for each of the variables. In order to detect factors which cause dissatisfaction with residency, a comparison between the global level of satisfaction with residency and the rest of variables was carried out using the chi-squared test, together with an analysis of residues and Fisher's exact test where necessary. A value of p below 0.05 was considered to be statistically significant.
With respect to the evaluation of seminars carried out in various departments (emergency, clinical, bibliographical, and morbidity/mortality), clinical seminars are routine in most departments (69%). However, as can be seen in table I, a high percentage of residents do not have or only occasionally have access to seminars of different types in their departments. Therefore, 85% claim to never or only occasionally have morbidity/mortality seminars; the same is true of bibliographical seminars in 59% of cases.
As far as training is concerned, as can be seen in table II, this varies according to the type of case analyzed. Thus, for clinical care training only 15% are dissatisfied or very dissatisfied, while this rate rises to 36% in the educational training evaluation, and to 68% for investigative training.
Concerning scientific studies, 49% of residents have not written any article, and the number of published scientific studies increases as the residency progresses, without differences according to specialist group. On the other hand, 22% of residents report having not started their doctoral thesis, 50% report having participated in doctorate courses, 24% have the topic for their thesis, and only 4% have completed their thesis. Doctorate courses, thesis topic, and the written completion of a thesis increase with the year of residency, and a greater activity was seen in this respect at surgical departments. If we analyze facilities available for residents to carry out scientific activities, 19% report that there are many, 55% that only some staff physicians are available, and 21% that no physicians are available. When considering facilities for attending courses and congresses, 46% report that there are many, 34% that there are only some with certain staff physicians, and 17% that there are none.
On analyzing the results with respect to year of residency, we observed that residents in their 4th or 5th year are more dissatisfied with their research training than the rest, even though these are the ones with a higher percentage of doctoral theses, thesis topics, and scientific studies completed. Residents in their fifth year, who mainly belong in specialist surgical areas, report having more facilities for carrying out scientific activities (Table III).
If the analysis is based on specialist area, it can be seen in table IV that residents in the field of surgery carry out more theses. On the contrary, residents (MIRs) in central areas report having less facilities for carrying out scientific activities or for being able to attend courses and congresses. Finally, if we evaluate the influence that these variables have on the resident's general satisfaction with residency, it can be seen that they are significant factors of dissatisfaction (Table V).
Research and scientific training is fundamental for a good doctor, as it will allow him or her to be critical with information received, and to make his or her own advances in medicine. It has to be reminded that the fundamental aim of research in clinical medicine is to generate the knowledge that may contribute to a better understanding and utilization of the doctor's own skills in the discipline, his or her clinical care profile, as well as influence the biological, psychological and social surroundings related to the health-illness phenomenon. We cannot let those health professionals who we train be merely good technicians receptive of what others research. A critical and investigative mentality is a fundamental aspect in improving daily clinical care, as it allows the doctor to research problems found in patients in order to find solutions. What is more, such a mentality will let the doctor discern important medical advances among the avalanche of scientific information that we are faced with every day.
However, this investigative activity has always taken a backseat position in resident training, and there is little referenced information published about this topic. Accordingly, Rodríguez et al. (7), in a study carried out in residents in their fourth year of internal medicine of the digestive diseases, already reported that there are few facilities for carrying out research activities, above all for doctoral theses. These data correlate with our own, which show that 68% of residents are dissatisfied with their research training, and only 28% have a thesis topic or have undertaken their thesis. It is important to comment that what is fundamental is to encourage research activity, and that the necessary bases should be acquired for carrying out such research as staff physicians. In fact, those who acquire such abilities usually complete their doctoral thesis, but this may well be after finishing their residency (11). It should be taken into account that the profile of a resident (MIR) is that of a young graduate (aged 27 ± 7 years) who has not had to sit a MIR exam on too many occasions, and, as this training is his/her first activity as a doctor, it is a really crucial stage for the rest of her or his professional life.
Moreover, currently, above all in specialist areas with a high level of unemployment, research has become a major source of employment (11). Thus, in certain specialities, after a training period, more than half of residents have continued their connection with their departments as research assistants with grants, thus carrying out research tasks (11). However, it must be said that this is not the best option, as it creates a situation of underemployment that forces doctors to have more than one job, with the clearest example being contracts for doing day and night duty in order to earn an acceptable level of income. Additionally, it must be considered that research and scientific activity is an expectation that most residents have when they arrive at a hospital. Therefore, when such an expectation is not fulfilled it becomes a factor of dissatisfaction (7). In our study we have seen that the different variables related to research are factors for dissatisfaction when they are not fulfilled, as seen in table V.
In this sense, the figure of the tutor is without doubt a crucial element. This person is responsible for carrying out essential tasks for resident training quality, such as training plans for each resident, direct and continued supervision of residents in their work, a continued evaluation of their learning, and making the most of training received. Therefore, this figure is fundamental for completing resident research training.
Our study highlights how dissatisfaction towards research training increases with the year of residency, and how research expectations are not fulfilled. This is only logical, as the "younger" first-year resident always thinks that there is time to learn, but as the end of residency approaches he or she realizes what the limitations of their training have been.
Although this questionnaire is not totally applicable to all hospitals, since each hospital has its own peculiarities, in general terms, problems are similar -there are sufficient data to confirm dissatisfaction of internal residents with their scientific training, and the facilities they have for carrying it out are relatively scarce, which is why options should be sought to resolve this negative effect on training.
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