What is CERA?
The CAFM Educational Research Alliance (CERA) is a resource to help focus and support medical education research efforts of the discipline. CERA is intended to:
- Increase published research and scholarly activity among members of the Council of Academic Family Medicine (CAFM) organizations by providing infrastructure and consultation
- Improve the process for surveying constituents with better questions and fewer surveys
- Provide a clearinghouse of data CAFM members and their residents can use to meet scholarly activity requirements
- Provide mentoring and education to junior researchers
Although the family medicine organizations have been active for many years in conducting research skill-building seminars at their annual meetings, this initiative is different in that it provides an infrastructure, collaboration and expertise to actually conduct studies.
How Did CERA Get Started?
In July 2009, the four CAFM organizations (the Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, North American Primary Care Research Group, and the Society of Teachers of Family Medicine) prioritized the need to create a more vigorous family medicine research pipeline. A small CAFM work group devoted a significant amount of energy to outlining an action plan to accomplish this. The plan contained a number of suggestions for various organizations to consider to improve the quality and quantity of research being produced within family medicine.
Three of the organizing principles outlined in that document were:
- Collaborative Team and Network Development to reduce isolation and improve effectiveness: research infrastructure development should build teams and consortia (across departments of family medicine and other specialties) that reduce isolation and build on the success of established programs and investigators.
- Outcome focused: Our efforts should have measurable outcomes, and we should consider building both an infrastructure to achieve the desired outcomes for the discipline and a mechanism to monitor the results.
- New models: Explore new models of research organization for the discipline: “hub and spoke” (Mainous 2006), research training at different stages of a family physician’s career, virtual research networks, and centers, etc.
The STFM Research Committee and STFM Board took the concepts identified in that research pipeline document and proposed the creation of the CAFM Educational Research Alliance as a means to help focus and support medical education research efforts. Following nearly 2 years of planning, the first CERA study was sent in June 2011 to all residency program directors.
Who Oversees CERA?
A 13-member CERA Steering Committee makes decisions on proposals and provides mentorship to applicants. One to two CERA Steering Committee members are assigned to each accepted proposal within a CERA survey, and these individuals assist the primary investigators with question formation, data analysis, and manuscript development. STFM provides staff leadership for the initiative, but all CAFM organizations provide financial support for CERA.
How Do I Get My Research Project Questions in the Next CERA Survey?
CERA sends a call for proposals to CAFM members prior to each CERA survey. Proposals are assessed according to logistical and technical considerations, as well as to the significance and new knowledge to be yielded. Priority is given to content that is likely to yield a high quality peer-reviewed publication. The CERA Steering Committee reviews proposed content and provides comments to proposers.
Is There a Limit to Questions One May Submit for a CERA Survey?
The CERA Steering Committee generally limits the number of questions on a given topic to 10. This means 10 total, not 10 with 5 subparts each. This allows the committee to include a reasonable number of proposals in each survey and forces researchers to ask focused questions.
What is the Process and Criteria for Evaluating CERA Questions and Deciding Which Get Included?
The CERA Steering Committee reviews the applications and determines which topics will be included. Criteria that go into that decision include (but are not limited to): the amount of room available in the survey so as to not overwhelm members, the novelty of the submitted questions, and the likelihood of being able to publish the results. A few vocal members have questioned some survey topics. The committee has put measures into place to ensure clear communication of survey topics; however, CERA will continue to consider scientifically valid questions on topics some members may consider to be sensitive.
How Many Surveys Does CERA Conduct a Year and Whom Do They Survey?
Based on experience with proposals received thus far, our plans are to survey the following audiences:
- Clerkship directors and/or other medical school faculty (once annually)
- Family medicine residency directors (twice annually)
- General CAFM membership, including member subsets, such as department chairs, behavioral science faculty, and other residency faculty as requested (once annually)
Each survey includes questions on multiple subjects, as well as a set of recurring questions to provide data for historical comparisons. Recurring questions may include:
- Demographics of medical schools, residencies and fellowship programs, eg, university- vs. community-setting, number of trainees, etc.
- Graduate statistics of medical schools, residencies and fellowship programs, eg, % of medical students who enter family medicine, % of residents who practice in rural areas, numbers of fellows in geriatrics programs, etc.
- Curricula questions targeting medical schools, residencies, and fellowship programs, eg, clerkship clinical topics, and residency and fellowship competencies.
Is CERA for Primary or Secondary Research Only, or Can CERA Organizations Include Questions About their Products/Services?
The answer is, “it depends on the questions.” There is a tension between CERA wanting to be supportive of organizational questions and wanting to ensure an appropriate response rate. Questions with responses of enduring value, useful for benchmarking or leading to publishable studies would be useful to include in CERA. Questions that don’t have this enduring value or those that are intended for one organization’s members are not appropriate for CERA. Mixing in too many questions about products/services might significantly dilute the response rate.
Is CERA Intended to Replace All Surveys From CAFM Organizations to Their Members?
No. Each organization still maintains the authority to conduct its own internal surveys. That said, CERA is more likely to become a widely accepted, robust vehicle for research if additional surveys are minimized. One of the chief goals of the omnibus survey is to limit the absolute number of surveys individuals get each year. Questions that have enduring value can be rolled into CERA surveys. There may be organizational questions that should not be included in CERA, eg, questions to acquire data that will remain private to one organization’s members.
What About IRB Approval?
CERA omnibus surveys use the American Academy of Family Physicians IRB, a federally approved IRB. Investigators should follow their local IRB policies regarding use of the data.
What if I Need Mentoring?
A benefit of CERA is that institutions that don't have a strong research infrastructure or experienced investigators can receive help in moving from an idea to publication. The CERA Steering Committee is available to answer questions and assist individuals in preparing proposals. Once projects have been approved, experienced researchers from the CERA steering committee join each project team to help refine questions, facilitate analysis, and prepare and submit manuscripts. Because of their extensive involvement with the project, researchers who join your team should be included as authors on published papers/presentations.
What is the CERA Clearinghouse?
Data is collected through STFM and housed at STFM under the oversight of the CERA Steering Committee. Data is released online to CAFM members in a variety of formats. Individuals who submit specific questions for study are given 3 months to analyze the data from the survey prior to release of the data to the general membership. The expectation is that investigators will write and submit a paper within those 3 months.
Survey results include demographic information in addition to responses to submitted survey questions that target the entire group or sub-populations. This data can be used by faculty and residents to meet scholarly activity