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Determinants of research engagement in academic obstetrics and gynaecology Fernandez, Ariadna; Sadownik, Leslie; Lisonkova, Sarka; Cundiff, Geoffrey; Joseph, K. S Apr 16, 2016

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RESEARCH ARTICLE Open AccessDeterminants of research engagement inacademic obstetrics and gynaecologyAriadna Fernandez1*, Leslie Sadownik2, Sarka Lisonkova3, Geoffrey Cundiff4 and K. S. Joseph3,5AbstractBackground: To identify the determinants of research engagement among faculty in an academic department ofObstetrics and Gynaecology.Methods: All members of the Department of Obstetrics and Gynaecology at the University of British Columbiawere mailed an online version of the Edmonton Research Orientation Survey (EROS) in 2011 and in 2014. Highscores on overall research engagement and on each of the 4 subscales, namely, value of research, value ofinnovation, research involvement and research utilization/evidence-based practice were quantified. Analyses werecarried out on both surveys combined and on the 2014 survey separately. Logistic regression was used to identifydeterminants of high levels of research engagement.Results: The overall response rate was 37 % (130 responses; 54 respondents in 2011 and 76 respondents in 2014).The average EROS score was 140 (range 54 to 184) and 35 % of respondents had a score ≥150. Significantdeterminants of positive research engagement based on the overall EROS scale included being paid for researchwork (adjusted odds ratio [AOR] 22.1, 95 % confidence interval [CI] 2.47–197.7) and carrying out research duringunpaid hours (AOR 6.41, 95 % CI 1.97–20.9). Age <50 years (AOR 11.0, 95 % CI 1.35–89.9) and clinical experience<20 years (AOR 19.7, 95 % CI 2.18–178.8) were positively associated, while journal reading during unpaid hours(AOR 0.21, 95 % CI 0.07–0.62) was negatively associated with specific EROS subscales.Conclusions: In a setting with a positive research orientation, research engagement among the faculty wasassociated with paid research time, research work and journal reading during unpaid hours and more recent entryinto clinical practice.Keywords: Obstetrics, Gynaecology, Attitude, Research involvement, Evidence-based practiceBackgroundEngagement of clinicians in research is essential for ensur-ing that relevant clinical questions are posed and addressed.Also, clinical experts sometimes have valuable insights thatcan lead to unexpected advances in medical science. Thecausal link between thalidomide and phocomelia was madesimultaneously by an obstetrician, William Mcbride, and apediatrician, Widukind Lenz, based on routine clinicalobservation [1–3]. Similarly, clinical insight obtained inroutine practice led to the discovery that diethylstilbestroluse in pregnancy caused clear cell vaginal adenocarcinomain daughters decades later [4, 5]. It is even claimed thatobstetrician John Snow’s attribution of cholera epidemics tocontaminated drinking water was based on a clinical con-viction that was merely confirmed by subsequent epidemio-logic research [6, 7].Recognition of the clinician’s key role in advancingmedical science notwithstanding, academic faculties anddepartments struggle with the challenge of effectivelyengaging clinical faculty in research [8–14]. There aremany obstacles to clinician engagement and prominentamong these challenges is the recruitment, training andretention of clinician researchers. Although a significantproportion of medical students express a strong interestin securing a full-time academic appointment with re-search involvement, resource issues hamper recruitmentof clinician scientists. Specific issues include remuner-ation for research, anxiety regarding the competitive* Correspondence: afernandez@phsa.ca1Department of Obstetrics & Gynaecology, Faculty of Medicine, University ofBritish Columbia, Room C427- 4500 Oak Street, Vancouver, BC V6H 3N1,CanadaFull list of author information is available at the end of the article© 2016 Fernandez et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Fernandez et al. BMC Medical Education  (2016) 16:111 DOI 10.1186/s12909-016-0640-2nature of research funding, inadequate research infra-structure and lack of protected time for research [8].In 2010, the Department of Obstetrics and Gynaecologyat the University of British Columbia created a FacultyForum for Research dedicated to increasing clinician in-volvement in research. This effort is supported by a gener-ous philanthropic donation, the Fred Bryans endowment.Given the goal of fostering an improved research culturewithin the department, we carried out a study exploringthe determinants of positive research engagement amongthe faculty.MethodsIn 2011 and 2014, the Edmonton Research OrientationSurvey (EROS) was circulated to all faculty memberswithin the Department of Obstetrics and Gynaecology atthe University of British Columbia (UBC). The study re-ceived Research Ethics approval from the University ofBritish Columbia/Children’s and Women’s Health Centreof British Columbia Research Ethics Board. The EROS isa validated tool developed to measure beliefs, attitudesand involvement in research [15–18]. The questionnaireconsists of 38-items rated on a 5-point Likert scale from 1(strongly disagree) to 5 (strongly agree). Four subscalesmeasure respondents’ value of research, value ofinnovation, research involvement, and research utilization(i.e., evidence-based practice). EROS was developed to “as-sess the degree to which individual’s clinical practice is in-fluenced by research findings” and the scale and itssubscales are promising measures of research utilizationand attitudes toward research [15, 16]. Each sub-scale ismade-up of several items from the 38-point scale and isintended to measure various aspects of research orienta-tion. Valuing Research pertains to a positive attitude to-wards research (e.g. “Even when funds are severelylimited, it is important to support research activities.”); Re-search Involvement pertains to active participation in re-search (e.g. “I am actively involved in doing clinicalresearch”; Being on the Leading Edge reflects value forinnovation and change (e.g. “I am constantly looking fornew information to help with my work.”; Evidence-BasedPractice refers to whether or not respondents self-reported using research to guide their day to day practice(e.g.“ Reading the research literature has changed the wayI practice.”) [16].In 2011, we circulated the EROS survey via e-mail toall faculty members (n = 155), including two reminder e-mails. Address errors resulted in 10 emails beingreturned, and 61 completed responses were received(61/145; 42 %). In 2014, we recirculated the survey via e-mail to all faculty members (n = 208), followed by tworeminder e-mails. No email address errors were encoun-tered and 83 responses were received (83/208; 40 %).The responses from 2011 to 2014 were combined andanalysed. Of the 144 survey questionnaires received, 14were excluded from the analysis because the responseswere substantially incomplete; thus a total of 130 re-sponses were included in the study (overall response rate130/353; 37 %).We first analysed the 2011 and 2014 surveys separatelyin order to assess potential changes in research engage-ment over time. Since both surveys showed similar re-sults, the responses from the 2 surveys were combined.However, the combined 2011 and 2014 survey analysisincluded the duplicated responses of some participantswho would have responded to both surveys. The anon-ymized nature of the surveys prevented the identificationof such respondents, and we attempted to assess poten-tial distortion of our findings due to such duplication bycomparing the results of the 2014 survey with the resultsof the combined 2011 and 2014 surveys. Sensitivity ana-lyses present the results of the 2014 survey alone.Characteristics of faculty members that were examinedas potential determinants of research engagement in-cluded age, years of clinical experience, research degree,length of work week, journal reading during paid andunpaid hours and research work during paid and unpaidhours. For this analysis, we categorized all respondentsinto those who had high scores (i.e., scores of 4 or 5 on30 or more of the 38 EROS items) or lower scores. Sep-arate analyses identified determinants associated withhigh scores on each of the EROS subscales. Respondentswho scored 4 or 5 on 6 or more of 8 items on the valueof research subscale, 4 or more on the 6 items on thevalue of innovation subscale, 8 or more on the 10 itemsof the research involvement subscale and 5 or more onthe 7 items of the research utilization/evidence-basedpractice subscale were considered to have a high scoreon that subscale. Logistic regression was used to quan-tify the independent association between each determin-ant and a high EROS score using adjusted odds ratios(AOR) and 95 % confidence intervals (CI). Analyses wasfirst carried out for all items on the EROS combined andalso separately for each of the EROS subscales. A 2 sidedP value < 0.05 was considered statistically significant.ResultsThe overall response rate was 37 % (130 responses of353; 54 respondents in 2011 and 76 respondents in2014). The majority of respondents (54 %) were under50 years of age and 58 % of faculty had less than 20 yearsof clinical experience (Table 1). A significant majority ofrespondents (72 %) had completed a course in statisticsor research design; 52 % reported doing research workduring unpaid hours; 21 % reported reading journalsduring unpaid hours; 35 % reported doing research dur-ing paid time and 34 % reported reading journals duringpaid time. Survey respondents were representative of allFernandez et al. BMC Medical Education  (2016) 16:111 Page 2 of 8faculty members in the department in terms of type of pos-ition (clinical versus tenure track) and membership by div-ision in General Obstetrics and Gynaecology, GynaecologicOncology, Gynaecologic Specialties, Maternal Fetal Medi-cine, and Reproductive Endocrinology and Infertility. Thestudy population was also similar to the overall Departmen-tal membership in terms of age (approximately 53 % of theDepartment members were <50 years of age). Details ofother respondent characteristics are shown in Table 1.The average EROS score was 140 (standard deviation24), with a range extending from 54 to 184 (maximumpossible EROS score 190). Most respondents (59 %) hasan EROS score between 100 and 149, 35 % had a scorebetween 150 and 190 and a small fraction scored lessthan 100 (Table 1).Table 2 shows the frequency of respondents with highEROS (scores of 4 or 5 on 30 or more of the 38 EROSitems). High scores were more prevalent among thosewho had previously attended the research forum, did re-search work during paid hours or unpaid hours or wereclinicians, administrators or others (i.e., relative to re-searchers). Work <50 h per week was associated with ahigher scores, although this was of borderline signifi-cance. Having a Masters degree or a PhD degree waspositively associated with a high score on the EROS, al-though neither association was statistically significant(Table 2).Analyses restricting the study to the 2014 survey (76responses) showed that high scores on the EROS weresignificantly associated with research work during paidhours (OR 20.0, 95 % CI 1.83–219.1, P value 0.01) andresearch work during unpaid hours (OR 8.77, 95 %2.25–34.2, P value 0.002, Table 3 upper panel). Thesefindings were similar to analyses involving all respon-dents and therefore subsequent analyses presented in-clude respondents from both the 2011 and 2014 surveys(Table 3, lower panel). Research work during paid hours(AOR 22.1, 95 % CI 2.47–197.7, P value 0.006) and re-search work during unpaid hours (AOR 6.41, 95 % CI1.97–20.9, P value 0.002) were significantly associatedwith high scores on the EROS in these analyses combin-ing the 2011 and 2014 surveys. Supplementary analysescarried out after removing the 4 journal reading and re-search work variables from the model did not substan-tially alter the associations between the otherdeterminants and high scores on the EROS, with the ex-ception of work hours per week <50 (AOR 2.77, 95 % CI0.99–7.75, P value 0.05).Table 4 shows the factors associated with high scoreson value of research and value of innovation subscale ofEROS. Characteristics positively associated with a highscore on the value of research subscale were researchwork during paid hours (AOR 5.76, 95 % CI 1.28–25.8,P value 0.02) and research work during unpaid hours(AOR 4.19, 95 % CI 1.37–12.8 P value 0.01). Journalreading during unpaid hours was negatively associatedwith high scores on the value of research subscale (AORTable 1 Characteristics of Edmonton Research OrientationSurvey (EROS) respondents, Department of Obstetrics andGynaecology, University of British ColumbiaCharacteristic Number Percent(n = 130)Age<50 years 70 53.8Research degreeMSc 21 16.2PhD 12 9.2No MSc or PhD 97 74.6Research forum attendeeYes 57 44.5Years of clinical experience<20 74 58.3Attended research courseYes 93 72.1Work hours per week<50 95 74.2Journal reading during paid hoursYes 40 34.2Journal reading during unpaid hoursYes 40 31.5Research work during paid hoursYes 42 35.0Research work during unpaid hoursYes 60 51.7SpecialtyClinician 30 23.1Researcher 31 23.9Administrator 7 5.4Clinician specialist 46 35.4Other 16 12.3Do you have a current research project?Yes 76 58.5Do you make conference presentationsYes 73 56.2EROS scorea<100 8 6.2100–149 77 59.2150–190 45 34.6Subjects with missing responses not included (e.g., Journal reading duringpaid hours n = 117 and Research work during paid hours n = 120)a EROS score based on responses to 38 items each scored on a scale from 1 to 5Fernandez et al. BMC Medical Education  (2016) 16:111 Page 3 of 8Table 2 Proportion of survey respondents with high scoresa on the Edmonton Research Orientation Survey (EROS), Department ofObstetrics and Gynaecology, University of British ColumbiaCharacteristic TotalNo.Respondents with high scoresa Oddsratio95 % CI P valueNo. %Age<50 years 70 24 34.3 1.13 0.51–2.51 0.75>=50 60 19 31.7 1.00 (−) -Research degreeMSc 21 8 38.1 1.27 0.68–2.38 0.46PhD 12 6 50.0 1.67 0.88–3.18 0.19No MSc or PhD 97 29 29.9 1.00 (−) -Research forum attendeeYes 57 26 45.6 2.66 1.77–6.08 0.01No 71 17 23.9 1.00 (−) -Years of clinical experience<20 74 24 32.4 0.93 0.41–2.11 0.86>=20 53 18 34.0 1.00 (−) -Attended research courseYes 93 35 37.6 2.11 0.80–5.69 0.10No 36 8 22.2 1.00 (−) -Work hours per week<50 95 36 37.9 2.75 0.96–8.25 0.06>=50 33 6 18.2 1.00 (−) -Journal reading during paid hoursYes 40 15 37.5 1.33 (0.55–3.18) 0.49No 77 24 31.2 1.00 (−) -Journal reading during unpaid hoursYes 40 10 25.0 0.60 (0.24–1.50) 0.24No 87 31 35.6 1.00 (−) -Research work during paid hoursYes 42 27 64.3 8.23 3.23–21.4 <0.0001No 78 14 18.0 1.00 (−) -Research work during unpaid hoursYes 60 5 8.3 0.07 0.02–0.21 <0.0001No 56 32 57.1 1.00 (−) -SpecialtyClinician 30 16 53.3 5.94 1.58–23.7 0.002Researcher 31 5 16.1 1.00 (−) -Administrator 7 4 57.1 6.93 1.05–60.7 0.04Clinician specialist 46 9 19.6 1.26 0.33–4.97 0.70Other 16 9 56.3 6.69 1.41–34.1 0.007Do you have a current research project?Yes 76 28 36.8 1.52 0.67–3.47 0.28No 54 15 27.8 1.00 (−) -Fernandez et al. BMC Medical Education  (2016) 16:111 Page 4 of 80.21, 95 % CI 0.07–0.62, P value 0.005). None of thecharacteristics examined were significantly associatedwith high scores on the value of innovation subscale.Table 5 shows associations between respondent character-istics and high scores on the research involvement andresearch utilization/evidence-based practice subscales ofEROS. High scores on the research involvement subscalewere positively associated with conducting research duringpaid hours (AOR 14.6, 95 % CI 2.90–92.9, P value 0.001)and conducting research during unpaid hours (AOR 6.48,95 % CI 1.86–22.6, P value 0.003). The association betweenattending a course in research design or statistics and highscores on the research involvement subscale was borderlinesignificant (AOR 4.91, 95 % CI 0.94–25.6, P value 0.06). Thecharacteristics associated with a high score on the researchutilization/evidence-based practice sub-scale were age<50 years, clinical experience of <20 years and conductingresearch during unpaid hours. Respondents <50 years of agewere more likely to have a high score on this subscale (AOR11.0, 95 % CI 1.35–89.8, P value 0.03), as were those with<20 years of clinical experience (AOR 19.7, 95 % CI 2.18–178.8, P value 0.008) and those doing research work duringunpaid hours (AOR 8.15, 95 % CI 1.60–41.5, P value 0.01).DiscussionOur study showed a high level of positive research en-gagement among faculty, particularly among clinicians.In this setting, research work during paid and unpaidTable 2 Proportion of survey respondents with high scoresa on the Edmonton Research Orientation Survey (EROS), Department ofObstetrics and Gynaecology, University of British Columbia (Continued)Do you make conference presentationsYes 73 27 37.0 1.50 0.67–3.40 0.29No 57 16 28.1 1.00 (−) -Subjects with missing responses not included (e.g., 13 subjects with missing values not included in Journal reading during paid hours and 10 subjects notincluded in Research work during paid hours, etc.)a Respondents with high scores were those scoring 4 or 5 on 30 or more of the 38 items of the EROSTable 3 Logistic regression analysis showing respondent characteristics associated with high scores on the Edmonton ResearchOrientation Survey (all subscales), Department of Obstetrics and Gynaecology, University of British Columbia.Characteristic Adjusted odds ratio 95 % CI P valueRespondents to 2014 survey only (n = 76)Age <50 years 6.11 0.49–75.5 0.16Research degree: Yes 1.08 0.23–5.06 0.92Years of clinical experience <20 10.6 0.78–144.9 0.08Attended courses in research design: Yes 3.88 0.62–24.3 0.15Work hours per week: <50 1.09 0.23–5.29 0.91Journal reading during paid hours: Yes 0.12 0.01–1.34 0.08Journal reading during unpaid hours: Yes 0.86 0.21–3.58 0.84Research work during paid hours: Yes 20.0 1.83–219.1 0.01Research work during unpaid hours: Yes 8.77 2.25–34.2 0.002Respondents to 2011 and 2014 surveys (n = 111a)Age <50 years 1.74 0.40–7.63 0.47Research degree: Yes 1.22 0.35–4.24 0.75Years of clinical experience <20 4.15 0.81–21.4 0.09Attended courses in research design: Yes 2.40 0.59–9.75 0.22Work hours per week: <50 2.21 0.60–8.20 0.24Journal reading during paid hours: Yes 0.15 0.02–1.34 0.09Journal reading during unpaid hours: Yes 0.86 0.28–2.63 0.79Research work during paid hours: Yes 22.1 2.47–197.7 0.006Research work during unpaid hours: Yes 6.41 1.97–20.9 0.002The upper panel shows results of the 2014 survey, while the lower panel shows the results of the surveys in 2011 and 2014a19 subjects had missing values in the 2011 survey for Journal reading during paid hours, Research work during paid hours, etc. and were not included in theregression model)Statistically significant associations appear in bold textFernandez et al. BMC Medical Education  (2016) 16:111 Page 5 of 8hours was associated with a high level of research en-gagement. Analyses focusing on the subscales of re-search engagement showed that value of research waspositively associated with paid and unpaid research workand negatively associated with journal reading duringunpaid hours. No significant associations were observedwith value of innovation, while research involvementwas associated with paid and unpaid research work, andresearch utilization/evidence-based practice was associ-ated with age <50 years, years of clinical experience <20and research during unpaid hours. Having attended acourse in statistics or research design was positively as-sociated with research involvement, although this associ-ation was of borderline significance.Several of the findings of our study confirm that remu-neration issues strongly influence research engagementamong academic faculty. Although this issue has beenpreviously identified, adequate research funding for clin-ical faculty remains an obstacle. On a positive note,doing research during unpaid time was associated withresearch engagement, suggesting that inadequate remu-neration negatively impacts buts does not eliminate re-search engagement. Moreover, the higher level ofresearch utilization/evidence-based practice among theyounger respondents (as evidenced by the associationwith age <50 years and clinical experience <20 years) is atestament to the contemporary academic culture thathas placed a premium on such issues from medicalschool onwards. The high level of research engagementamong clinicians is also heartening, although this maypotentially highlight our failure to adequately harnessand translate this enthusiasm for research into researchactivity.The negative, albeit non-significant, association betweenhaving a research degree and value of research was unex-pected. One can speculate that this finding reflects frustra-tion among clinicians with research degrees who feelunfulfilled because of time and other professional pressures.On the other hand, our study also showed a strong positiveassociation (of borderline significance) between attending acourse in statistics or research design and a high score onthe research involvement subscale. The contrast betweenthese findings is noteworthy and future studies should seekto clarify why these 2 markers of research commitmentshow diametrically opposite associations with subdomainsof research engagement.The strengths of our study included the use of a vali-dated tool that is demonstrated to have high reliability andinternal consistency [15, 16]. Our 37 % response rate waslower than ideal but higher than rates of 30–34 % typicallyTable 4 Logistic regression analysis showing respondent characteristics associated with high scores on the ‘Value of Research’subscale and on the ‘Value for Innovation’ subscale of the Edmonton Research Orientation Survey 2011 and 2014 (n = 111),Department of Obstetrics and Gynaecology, University of British ColumbiaCharacteristic Adjusted odds ratio 95 % CI P valueValue of ResearchAge <50 years 0.34 0.08–1.49 0.15Research degree: Yes 0.34 0.10–1.14 0.08Years of clinical experience <20 0.58 0.14–2.50 0.47Attended courses in research design: Yes 1.58 0.54–4.67 0.40Work hours per week: <50 0.55 0.18–1.69 0.30Journal reading (during paid hours): Yes 1.71 0.47–6.28 0.41Journal reading (during unpaid hours): Yes 0.21 0.07–0.62 0.005Research work (during paid hours): Yes 5.76 1.28–25.8 0.02Research work (during unpaid hours): Yes 4.19 1.37–12.8 0.01Value for innovationAge <50 years 2.68 0.41–17.3 0.30Research degree: Yes 0.51 0.10–2.58 0.42Years of clinical experience <20 2.11 0.36–12.5 0.41Attended courses in research design: Yes 2.35 0.60–9.18 0.22Work hours per week: <50 2.23 0.58–8.60 0.25Journal reading (during paid hours): Yes 3.97 0.48–33.2 0.20Journal reading (during unpaid hours): Yes 0.43 0.12–1.55 0.20Research work (during paid hours): Yes 0.85 0.07–9.64 0.89Research work (during unpaid hours): Yes 3.88 0.52–28.8 0.19Statistically significant associations appear in bold textFernandez et al. BMC Medical Education  (2016) 16:111 Page 6 of 8reported for surveys among Canadian physicians (eventhough such rates vary widely) [19–21]. Nevertheless, theself-selected nature of survey respondents likely implies apossible overestimation in the relatively high rate of re-search engagement noted in our study. However, this self-selection bias is likely to have a more limited impact on theassociations noted in our study. Another weakness of thestudy was the relatively small study size, which affected theprecision of the estimates in logistic regression analyses.ConclusionOur study provides some evidence to suggest that re-search engagement in an academic department ishighly linked to remuneration issues. Other factorsthat also affect specific subdomains of research en-gagement include age <50 years, clinical experience<20 years and having attended a statistics or researchdesign course. These factors highlight some of thecomplexities involved in fostering research in academicclinical departments. Further studies and innovativeproposals are required to foster a research culture thatcan increase recruitment, training and retention ofclinicians in research endeavours.Ethics approval and consent to participateResearch Ethics approval for this study was granted by TheUniversity of British Columbia/Children’s and Women’sHealth Centre of British Columbia Research Ethics Board(UBC C&W REB), a UBC-affiliated Research Ethics Board(REB) for the Oak Street campus (http://www.cfri.ca/re-search-support/reb); reference number H15-00767.Consent for publicationNot applicable.Availability of data and materialsThe data from this research was collected under qualityassurance program of the departmental research pro-gram, and consent of participants for data sharing wasnot obtained. As per Research Ethics Board rules, theuntabulated data cannot be publicly shared as consentfor this was not obtained.AbbreviationsAOR: Adjusted Odds Ratios; CI: Confidence Intervals; EROS: EdmontonResearch Orientation Survey; UBC: University of British Columbia.Competing interestsThe authors declare that they have no competing interests.Table 5 Logistic regression analyses showing respondent characteristics associated with high scores on the ‘Research Involvement’subscale and the ‘Research Utilization/Evidence-Based Practice’ subscale of the Edmonton Research Orientation Survey 2011 and2014 (n = 111), Department of Obstetrics and Gynaecology, University of British ColumbiaCharacteristic Odds ratio 95 % CI P valueResearch InvolvementAge <50 years 1.42 0.26–7.86 0.69Research degree: Yes 0.70 0.18–2.77 0.61Years of clinical experience <20 0.94 0.16–5.47 0.94Attended courses in research design: Yes 4.91 0.94–25.6 0.06Work hours per week: <50 0.75 0.18–3.12 0.69Journal reading (during paid hours): Yes 0.79 0.16–3.99 0.77Journal reading (during unpaid hours): Yes 0.72 0.20–2.53 0.60Research work (during paid hours): Yes 14.6 2.90–72.9 0.001Research work (during unpaid hours): Yes 6.48 1.86–22.6 0.003Research Utilization/Evidence-Based PracticeAge <50 years 11.0 1.35–89.8 0.03Research degree: Yes 0.33 0.07–1.50 0.15Years of clinical experience <20 19.7 2.18–178.8 0.008Attended courses in research design: Yes 3.18 0.79–12.7 0.10Work hours per week: <50 2.12 0.48–9.36 0.32Journal reading (during paid hours): Yes 1.40 0.18–10.7 0.75Journal reading (during unpaid hours): Yes 0.76 0.23–2.53 0.65Research work (during paid hours): Yes 1.21 0.15–10.2 0.86Research work (during unpaid hours): Yes 8.15 1.60–41.5 0.01Statistically significant associations appear in bold textFernandez et al. BMC Medical Education  (2016) 16:111 Page 7 of 8Authors’ contributionsAF conceived, designed and carried out the study and drafted themanuscript. LS conceived the study, participated in its design and criticallyrevised the manuscript. GC participated in designing the study and helpedto critically revise the manuscript. SL and KSJ participated in the statisticalanalysis of the study and helped to critically revise the manuscript.All authors read and approved the final manuscript.Authors’ informationAF is the Research Program Manager for the University of British Columbia(UBC) and British Columbia Women’s Hospital and Health Centre,Department of Obstetrics and Gynaecology. LS is an Assistant Professor inthe UBC Department of Obstetrics & Gynaecology and the Project Leader ofFaculty Development & Educational Support in the UBC Faculty of Medicine.SL is an Assistant Professor in the UBC Department of Obstetrics andGynaecology. GC is Professor and Head of Department in the UBCDepartment of Obstetrics and Gynaecology. KSJ is a Professor in the UBCDepartment of Obstetrics and Gynaecology.AcknowledgementsK.S. Joseph is supported by an Investigator award from the Child and FamilyResearch Institute and a Chair in Maternal, Fetal and Infant Health ServicesResearch from the Canadian Institutes of Health Research (APR-126338). We thankthe Fred Bryans Faculty Forum Endowment for supporting faculty research.FundingNone.Author details1Department of Obstetrics & Gynaecology, Faculty of Medicine, University ofBritish Columbia, Room C427- 4500 Oak Street, Vancouver, BC V6H 3N1,Canada. 2Division of Gynaecologic Oncology, Department of Obstetrics &Gynaecology and Development & Educational Support, University of BritishColumbia, Vancouver, Canada. 3Division of Maternal Fetal Medicine,Department of Obstetrics & Gynaecology, University of British Columbia,Vancouver, Canada. 4Division of Gynaecologic Specialties, Department ofObstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.5School of Population and Public Health, University of British Columbia,Vancouver, Canada.Received: 16 September 2015 Accepted: 13 April 2016References1. Mcbride WG. Thalidomide and congenital abnormalities. Lancet. 1961;278:1358.2. Lenz W. Thalidomide and congenital abnormalities. Lancet. 1962;279:45.3. Thalidomide. 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Response rates in postal surveys ofhealthcare professionals between 1996 and 2005: An observational study.BMC Health Serv Res. 2009;9:160.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:Fernandez et al. BMC Medical Education  (2016) 16:111 Page 8 of 8

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