What research questions are recommended for residents in internal medicine?

Research Question Recommendations for Internal Medicine Residents

Internal medicine residents should focus on patient-specific clinical questions arising from direct patient care encounters, particularly addressing therapy, diagnosis, disease management, and prevention, as these questions most frequently lead to actionable changes in clinical decision-making and improved patient outcomes. 1

Priority Research Question Categories

Patient-Centered Clinical Questions

• Focus on therapy-related questions (43% of resident inquiries), followed by diagnostic questions (15%), disease management (13%), and prevention (9%), as these represent the most common and clinically impactful areas where residents encounter knowledge gaps 1
• Formulate questions using the PICO format (Population, Intervention, Comparison, Outcomes) to structure actionable research questions that can be systematically answered 2
• Prioritize questions that assess critical outcomes affecting morbidity, mortality, and quality of life rather than purely physiological measures 2

Quality Improvement Projects

• Engage in faculty-mentored, team-based quality improvement projects that measure adherence to evidence-based guidelines and develop interventions for clinical practice, as these provide experiential learning in system-based practice 3
• Select QI topics that address gaps in care delivery within your continuity clinic setting, focusing on chronic disease management, preventive care adherence, or care coordination 3
• Design projects that can be completed within the residency training period and formally evaluated through poster presentations 3

Research Question Development Framework

Identifying Knowledge Gaps

• Generate research questions directly from patient encounters in the outpatient setting, as 89% of these questions can be successfully answered and lead to changes in clinical decision-making in 78% of cases 1
• Focus on areas where clinical practice guidelines exist but knowledge gaps persist, such as chronic kidney disease staging, risk factor identification, and appropriate specialist referral timing 4
• Address common pitfalls in guideline awareness, including recognition of non-traditional risk factors and understanding of disease complications 4

Question Characteristics for Success

• Ensure questions are specific to individual patients rather than general medical knowledge queries 1
• Frame questions that can be answered using readily available evidence-based resources like UpToDate (45% most helpful) and peer-reviewed journal articles (42% most helpful) 1
• Select topics where answering the question will improve patient communication, increase confidence in care delivery, and enhance knowledge applicable to future patients 1

Recommended Research Topics by Clinical Domain

Core Clinical Topics

• Prioritize research questions in the most important clinical areas evaluated by internal medicine physicians, including cardiovascular disease, diabetes mellitus, chronic kidney disease, respiratory conditions, and preventive care 5
• Focus on topics where performance measures exist but evidence quality needs improvement or where measures lack high-certainty evidence of moderate net benefit 5

Specific High-Yield Areas

• Tobacco dependence treatment in patients with cancer, including optimal cessation strategies in time-constrained preoperative periods and management of withdrawal symptoms during chemotherapy 2
• COPD exacerbation prevention and management, addressing the 50-75% of COPD costs attributed to exacerbations 2
• Pain, agitation, and delirium management in intensive care settings, using structured evidence evaluation approaches 2

Research Methodology and Resources

Evidence Retrieval Methods

• Use Medline (73% of searches) and UpToDate (70% of searches) as primary information sources, as these are most frequently utilized and effective for answering clinical questions 1
• Apply systematic search strategies using medical subject headings (MeSH terms) and multiple clinical databases including PubMed, MEDLINE, Cochrane Database, CINAHL, and Scopus 2
• Limit searches to English-language manuscripts on adult humans with adequate sample sizes (>30 patients), excluding editorials, case reports, and animal studies 2

Evidence Quality Assessment

• Apply GRADE methodology to rate quality of evidence and grade strength of recommendations, distinguishing between high-quality RCTs (Level A), RCTs with limitations (Level B), and observational studies (Level C) 2
• Prioritize guidelines from major professional societies (American College of Physicians, American Heart Association, American Diabetes Association) over individual studies 6, 7, 8
• Consider factors affecting recommendation strength including quality of evidence, balance of benefits versus harms, patient values and preferences, and resource utilization 2

Stakeholder Involvement

Patient and Clinician Engagement

• Involve patients, clinicians, and other stakeholders in formulating research questions to ensure relevance and importance, as this reduces perceived burden and increases the value of findings 2
• Use workshops, surveys, focus groups, and consensus meetings to gather diverse perspectives on research priorities 2
• Recognize that patient perspectives may differ substantially from clinician and researcher priorities, particularly regarding outcome importance 2

Collaborative Approaches

• Organize workshops with 3-4 participants per discussion group, or larger full-day workshops with 20-25 participants divided into randomly assigned groups 2
• Consider mobile workshops (maximum 10 participants, 30-minute duration) to facilitate participation for those with busy schedules or mobility issues 2
• Apply consensus techniques like Delphi methodology when determining which outcomes to measure, ensuring completion of all rounds to avoid attrition bias 2

Implementation and Mentorship

Research Program Structure

• Establish a formal research director position (present in 92% of successful programs) to coordinate resident research activities, though only 58% require a formal research curriculum 9
• Require applications for research participation (80% of high-functioning programs), as this ensures resident commitment and appropriate project matching 9
• Allocate dedicated time and administrative support for research activities, as these are critical determinants of success 9

Mentorship Requirements

• Secure an effective faculty research mentor, identified as the most frequently associated factor with resident research success 9
• Ensure mentors have expertise in the specific research area and availability to provide regular guidance throughout the project 9
• Aim for two-thirds of research-involved residents to submit abstracts to regional or national meetings, as this represents a benchmark for successful programs 9

Expected Outcomes and Impact

Knowledge and Practice Changes

• Anticipate that answering patient-specific clinical questions will improve knowledge (mean rating 4.6/5), confidence in care (4.3/5), patient communication (4.3/5), and actual patient care (4.0/5) 1
• Expect information to affect clinical decision-making in approximately 78% of cases where answers are successfully found 1
• Recognize that knowledge and comfort with research methodologies improve progressively from PGY-1 through PGY-3, with mean performance scores increasing from 68.8% to 74.0% 4

Career Development

• Understand that meaningful research participation during residency prepares physicians for academic careers and enhances critical appraisal skills applicable to all practice settings 9
• Recognize that approximately two-thirds of residents in high-functioning programs engage in research during training, representing a substantial but not universal expectation 9