Focus on international research strategy and teaching: the FIRST programme

Research, education and patient care are important missions of academic health centres and their respective teaching programmes. Studies have shown that resident participation in research is correlated with an increased number of lifetime publications [1], encourages future careers as academics [2], increases subspeciality fellowship training opportunities [3], and can ultimately lead to improved patient care [4]. Despite the importance of resident scholarship, graduate medical education has historically focused on clinical service and education, with patchy and inadequate attention to research training [5]. In recognition of the importance of incorporating research into residency training, regulatory bodies worldwide, including the Arab Board for Medical Subspecialities, the United States based Accreditation Council for Graduate Medical Education and the United Kingdom’s Royal College of General Practitioners require scholarly activity for both trainees and faculty. Strategies for improving research productivity have included recruiting a post-doctoral researcher to coordinate and support resident projects [6]; implementing a multimodal educational intervention to provide training in research and statistics [7]; and developing a formal, structured research rotation [8]. These approaches, almost exclusively at the individual programme level, have had varying degrees of success, and training programmes in all disciplines continue to struggle with ways to provide effective research experiences [9]. These issues are even more pronounced in countries with developing medical education systems where inconsistencies in training programme structure and quality, along with the lack of uniformity in the backgrounds and experience of the faculty, can hinder meaningful research activities.

The United Arab Emirates (UAE) is a small nation bordering the Persian Gulf. Over the past two decades, the country has become a political and economic leader in the Arab World and is a rapidly developing region for medical education and biomedical research [10]. The opening of the first medical school in 1984 paved the way for the development of residency training programmes in the mid-1990s. Subsequently, small-scale, independent research initiatives developed in some residencies. However, research strategy was never formally introduced into the curriculum for postgraduate medical programmes. Without central oversight, inconsistencies developed in the quality and effectiveness of research training in the individual programmes and began to increase over time.

Medical education leaders in our institution recognized the need to inculcate both the desire and the ability to conduct quality research into every residency programme. Given the lack of global benchmarks, the institution developed and implemented a hospital-wide approach to research strategy training and support, the FIRST Programme (Focus on International Research Strategy and Teaching), in 2010–2012 using established principles of change management. We hope that lessons learned from our experience will provide a foundation for research strategy and teaching in similar international teaching hospitals.

Tawam Hospital is a Joint Commission International-accredited 467-bed tertiary care centre in Abu Dhabi in the UAE. Tawam sponsors nine residency and fellowship programmes and serves as a training site for medical, nursing, and clinical pharmacology students from various institutions of higher education. The institution received ACGME-International accreditation in 2012.

To bring about significant and enduring changes in the institution’s approach to research training, educational leaders turned to classic theories of organizational development and change management [11, 12]. The basic tenets include creating compelling reasons to change (unfreeze); implementing the necessary changes (move); and developing systems for sustainability (refreeze) [12].

Prior to 2010, few residents and faculty at Tawam Hospital were involved in research. Review of 2008 and 2009 submissions to the Institutional Review Board (IRB) did not reveal any resident collaborators. Peer-reviewed publications were infrequent for faculty and consisted mainly of case reports. Graduate surveys revealed that only 47.1 % of graduating residents considered themselves competent to evaluate clinical evidence and even fewer (35.3 %) felt comfortable conducting clinical research. The most commonly identified barriers included lack of time due to competing pressures of patient care and education, lack of knowledge of basic research methodology and statistics, and unavailability of knowledgeable mentors.

Over a 3-year period (2010–2012), sessions dedicated to assisting residents with activities, such as idea generation and research design, increased by 733 %, including an increase in workshops focusing on methodology (345 %) and research ethics (183 %). A sevenfold increase from 2 resident projects in 2010 to 14 in 2012 was observed for research studies registered at the hospital’s central clinical research database and approved by the IRB. The institution also noted a transformation from limited basic science research conducted by the faculty prior to 2010 to translational studies after 2010, with many involving resident collaborators. There was a steady increase in retrospective chart reviews to assess incidence and prevalence, behavioural studies to assess quality of life, observational studies, such as disease registries, and phase II, III and IV clinical trials (Fig. 1). Phase 1 clinical trials are not permitted by the regulatory authorities in the UAE.