Get With the Program
Authors:   , Byers Alisa Patrice , Perry Constance K. 
Published: April 2023

Learning health systems (LHS) integrate data science, quality improvement, and medical research to inform continuous improvement and optimize patient care. In a LHS, physicians need to consider how to foster evidence-driven research, disseminate results and integrate the evidence generated. This consideration is needed even if they do not choose a research career pathway to manage the influx of clinical research and quality improvement research studies. Studies show that internists do not see a value in strong research skills and do not think research skills need more emphasis in training. Internists have arguably the most opportunity to prevent disease and promote health in a LHS because they account for more than 13% of the physician workforce; however, they are only 0.019% of physicians who identify research as their major professional activity (AAMC, 2018). The accelerated pace of discovering and disseminating evidence, as seen in the LHS, has the potential to overwhelm physician workforce unequipped to pursue research and cyclically implement research outcomes into clinical care. The boundary between the clinician and researcher becomes blurred in a LHS, making a clinician's ability to implement quality research and manage these ethical dilemmas throughout the research process pertinent to clinical care (Hay-Smith, Brown, Anderson, & Treharne, 2016; Platt, Raj, & Wienroth, 2020). The Accreditation Council of Graduate Medical Education (ACGME) does not explicitly prepare clinicians to research sensitive topics or manage the ethical challenges that arise from combining research and clinical care (Hay- Smith et al., 2016). The need to build a research workforce of physicians capable of operating in a LHS may be achieved with a commitment from the ACGME to integrate Agency for Health Care Quality Research (AHRQ) - supported competencies of a LHS researcher into the ACGME common program requirements. The intent of the programmatic assessment described in this paper is to identify where the AHRQ- supported competencies can expand the ACGME curricular program to increase clinician's skills to develop and evaluate ethical research in a LHS. This stepwise qualitative study used thematic analysis to assess the overlap between ACGME program requirements and AHRQ-supported competencies to create LHSGME competencies. The shared LHSGME competencies were translated into themes using content analysis. Content analysis was also used to determine if the key LHS-GME themes included concepts related to the expertise for evaluating ethical proposal development skills according to the Emmanuel Framework (Emanuel, Wendler, & Grady, 2000). The findings from this study indicate that the ACGME curriculum lacks an emphasis on LHS skills in informatics, research methods and quality improvement. Additionally, ethical concepts such as informed consent, fair participant selection, scientific validity, and respect for potential enrolled participants are not clearly stated in the combined LHSGME curriculum. These curricular deficits weaken the clinicians' understanding of fundamental research ethics and may contribute to ineffective LHS research designs which fail to integrate stakeholder needs of the community, expose participants to unnecessary risks, and produce unreliable results (Harris, 2017). GME programs should further integrate ethical research skills to permeate their current curriculum.