Teaching Scholarship and Who Needs to Learn It Free

Thomson et al¹  present a framework for developing scholarship during fellowship. They correctly identify the challenges fellows and fellowship programs face, including time, resources, and currently available mentorship. They report on the efforts of a national group of pediatric hospital medicine (PHM) educational and research leaders to develop scholarship core competencies. The end product should be generalizable to include scholarship in educational research, as well as quality improvement, and also should be able to be used by other pediatric specialties. The competencies themselves should be the focus of ongoing evaluation to ensure its effectiveness.

It is worth noting that the research productivity of PHM fellows before 2016, when the PHM applied to the American Board of Pediatrics for specialty designation, was high. In fact, the scholarly production of the first generation of PHM fellows greatly impacted the success of the PHM petition. It is likely that at a time when fellowship was not required, the cohort of early PHM fellows was highly self-motivated to obtain additional training in nonclinical areas, such as research training, to pursue an academic career. Now that fellowship training is required to achieve PHM certification, it is possible that not all PHM fellows will be equally motivated to learn research skills, which will increase the utility of a formal research competency.

The need for PHM fellows to be competent in research raises some larger issues about fellowship training and certification. One is why is research training necessary. The stated goal of the American Board of Pediatrics for all fellowships is to train people to work in an academic environment. That equates to creating scholarly products. Clinical work is the milieux of most PHM scholarship, so the fellowship duration of 2 years versus 3 years should be less impactful on the successful completion of scholarly endeavors than for scholarship that is dependent on extensive nonclinical activities, such as bench research. It is also worth considering if even 3 years is sufficient for truly meaningful projects that, at least, give the fellows a good chance of obtaining grant funding. Older data from the National Institutes of Health revealed that attaining an R01 takes 4 to 6 years from the first application.²  More recent changes in funding have jeopardized development funding and limited possible success for those institutions with significant existing research infrastructure.³ 

Are fellowships necessary to teach research skills? It is clear that residency training is not the venue for developing scholars, although the general pediatric training curriculum includes basic research concepts. Certainly, research skills can be acquired by different means than fellowship training, such as other graduate degrees and even self-study with or without mentorship. The benefit of curricula such as this is that it standardizes the content and ensures that all fellows are receiving a similar quality exposure that is anticipated to have a successful result. Barrett et al, in explaining the American Board of Pediatrics’ support of the PHM petition for specialty status, concluded that “certification requiring accredited training would encourage progress toward a standardized PHM curriculum”.⁴  The curricula developed by Thomson et al support that statement. Further experience with this curriculum will confirm if these specific goals and objectives prove successful.

Perhaps more important than the scholarly products themselves is the process of understanding and creating scholarship. We will be depending on future fellowship graduates to not just generate scholarship but to direct the agenda and properly vet and implement new science. A strong grounding in the research process will hopefully allow fellows to be better at bench-to-bedside care and translational research. Barrett et al further concluded that “As a new subspecialty, PHM is likely to accelerate improvements and innovation…” There is no question that a firm grounding in the development of scholarship is necessary to achieve that promised outcome.