Introduction Inadequate scholarship is a common concern in graduate medical education. Many barriers to scholarship have been identified, but there are limited data on which are most important. A rank-order of barriers from learners’ perspectives would better enable programs to address perceived barriers.

Methods Given that learners are experts in their own perceptions, we applied the Delphi method of generating consensus expert opinion to construct ranked lists of physician-perceived barriers to scholarly activity at various sites. The survey was conducted within three separate health systems. Respondents were asked to identify their perceived barriers via free text and the listed barriers were consolidated by the research team. In the second round, respondents were presented with the consolidated lists and asked to rank them. In the third and final round, each respondent was shown a comparison of their own rankings to that of their peers and given an opportunity to make changes. Ranking differences between programs were compared using Rank Biased Overlap (RBO).

Results The Delphi method is a straightforward method to obtain a ranked list of perceived learner barriers to scholarly activity; its primary limitation is learner engagement and, of note in our study, high dropout rates. RBO is an effective method of ranking differences between programs and specialties. Top barriers across programs included time, overwhelm with the research process, and lack of interest or energy.

Discussion Several of the identified barriers may be addressed with enthusiastic mentors, streamlined administrative processes, and education. This could be done within a hospital system or on a national level through specialty organizations.

The authors have declared no competing interest.

This study was funded in part by the Hanna Center for Primary Care Research at Reading Hospital.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board from Cooper, Penn State, and Tower Health organizations reviewed and approved this study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

ldennis1pennstatehealth.psu.edu

traci.deanertowerhealth.org

adam.sigaltowerhealth.org

drabagopennstatehealth.psu.edu

hdongpennstatehealth.psu.edu

jwiedemerpennstatehealth.psu.edu

areedycooperpennstatehealth.psu.edu

Jessica.Parascandocuanschutz.edu

kclebakpennstatehealth.psu.edu, Scopus Author ID: 55619459400.

cassidy-smith-taracooperhealth.edu

rlennonpennstatehealth.psu.edu, Phone: 904-588-2621 Fax: 717-531-4327

oms42drexel.edu

All data produced in the present study are available upon reasonable request to the authors