Resident Research Training
At Queen's Anesthesiology, research is an integral part of residency training.
Our residency research training plan is based upon the following rationale:
Is research a necessary part of anesthesia training?
The principles and practice of anesthesiology are founded upon physiology and pharmacology which have their roots in basic research, and more recently, epidemiological research. Recent revolutions in patient care are results of pioneering research (e.g. muscle relaxants, "quick-offset" anesthetics, regional anesthesia, pulse oximetry). Patient care is facilitated by practice guidelines & consensus recommendations (e.g. advanced cardiac life support (ACLS), difficult airway algorithm) which are based largely on clinical research. Recent major advances in investigative techniques, research funding and global research productivity have provided tremendous opportunities for anesthesia research in Canada. Clinical medicine is not practiced in a vacuum but rather in an ever-changing environment of research and innovation. Anesthesiology training must incorporate research in order for our specialty to advance among the forefronts of medicine.
How can anesthesia residents receive research training?
Role models and mentorship are crucial to residency research training and thus requires department-wide faculty involvement. Anesthesiology residents come from diverse backgrounds and identify with faculty with diverse strengths (e.g. clinical, teaching, research, administration). If ALL faculty emphasize the importance of research, it is much more likely that this message will come across to residents.
Firstly, one needs a structured introduction to the fundamentals of biomedical research (e.g. research methods course) followed by the development and execution of a research project(s). Clinical training is demanding and time consuming; therefore a practical plan and timetable for research project completion is critical. Communication of ideas is vital for research, thus emphasizing the importance of: a) "resident research day" - a forum for oral presentation of research proposals & results and b) publishing new knowledge in peer-reviewed journals (widespread knowledge translation).
Classical areas of research:
Biomedical research is traditionally hypothesis-driven in that it uses methods which test a specific hypothesis or question e.g. Does preload affect contractility? This type of approach has been used in several areas:
• describes previously unknown biological phenomena
e.g. Do excitatory amino acids transmit pain?
• prospective, randomized, double-blind clinical trials
e.g. Do beta-blockers decrease perioperative mortality?
• epidemiological studies (study the distribution and determinants of disease in a population)
e.g. Is postoperative nausea and vomiting more common in women than men?
Methods which use a random sample of subjects and are prospective, randomized, double-blind and controlled are least subject to bias and more likely to lead to a generalizable conclusion. Data from non-randomized studies, retrospective chart reviews and case series may generate new hypotheses but have serious limitations which could result in misleading conclusions.
Can clinically motivated questions be answered using research methods?
Routine clinical practice often gives rise to scores of "research questions" (i.e. unmet knowledge gaps) throughout one day in the operating room. Armed with curiosity, creativity and a thorough understanding of research principles many important questions can be, and have been, answered by carefully executing a research project plan. Some examples include:
Efficacy of treatment interventions, teaching, resource management:
• do preclinical teaching sessions improve intubation successes by medical students?
• what clinical features predict the likelihood of a failed spinal?
• what dose/duration of beta-blockade decreases perioperative cardiovascular risk?
• do intraoperative opioids cause postoperative hyperalgesia?
• does preoperative cardiac screening prevent perioperative morbidity and mortality?
• does a preoperative assessment clinic improve operating room efficiency?
What clinical features predict the likelihood of:
• difficult intubation?
• epidural hematoma?
• postoperative respiratory failure?
• failed weaning from cardiopulmonary bypass?
• intraoperative awareness?