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Participants in the 2007 CSDP workshop (left to right): (front) Eric T. Ricchetti, MD; J. Edward Puzas, PhD; Harry Kim, MD, FRCSC; Constance R. Chu, MD; Lawrence Gulotta, MD; (row 2) Michael Steven Hughes, MD; John Elfar, MD; Safdar N. Khan, MD; Samuel Bruce Adams, Jr., MD; Lance Michael Brunton, MD; Kevin J. Bozic, MD, MBA; (row 3) Joseph R. Carney, MD; Jonathan Lam, MD, PhD; Thomas J. Scharschmidt, MD; Gene Wurth, JD (OREF); (row 4) Denis R. Clohisy, MD; Edward Diao, MD; Andrew Schoenfeld, MD; LTC Steven Svoboda, MD; Matthew Steensma, MD; (row 5) Catherine K. Kuo, PhD; Morey S. Moreland, MD; Thomas Einhorn, MD; John Hardin, MD; (back) John H. Healey, MD; Brenda Frederick (ORS), Christy M.P. Gilmour (AAOS). (photo: Erin L. Ransford)

AAOS Now

Published 8/1/2007
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Erin Lynn Ransford

Becoming a clinician-scientist is no easy task

CSDP helps residents along the road with tips, mentors

Lance M. Brunton, MD, Safdar N. Khan, MD, and Jonathan Lam, MD, PhD, share a common goal: finding the perfect balance between a busy surgical practice, intensive laboratory research, and a fulfilling personal life. The three were among 14 aspiring clinician-scientists selected to participate in the 2007 Clinician Scientist Development Program (CSDP) sponsored by the American Academy of Orthopaedic Surgeons (AAOS), the Orthopaedic Research and Education Foundation (OREF), and the Orthopaedic Research Society (ORS).

The CSDP is designed for orthopaedic residents interested in pursuing careers as clinician-scientists. It provides an orientation to the research environment—including research history, funding sources, and orthopaedic research organizations—and enables residents to meet and interact with distinguished clinician-scientists and become paired with a faculty mentor in their field of study. The CSDP strives to nurture the growth of future leaders in orthopaedics.

Personal stories are key
“The highlights for me were the session on navigating the complexity of grant applications, the tips on negotiating for research/clinical requirements with departments, and most importantly, the personal anecdotes from the faculty on how to balance a busy clinician-scientist career with a fulfilling family life,” said Dr. Khan.

Dr. Khan always envisioned a career combining a clinical and research practice. A third-year orthopaedic resident at University of California, Davis, he jumped at the opportunity to participate in the CSDP. “As a resident, I strive to improve my understanding of the complex disease processes that form the basis of orthopaedic surgery.

The program seemed to offer just the tools I was looking for to continue my journey,” he said. His long-term career goal is to be an academic orthopaedic clinician-scientist.

Dr. Khan plans to pursue a fellowship in reconstructive spine surgery while maintaining a research focus in tissue engineering, fracture healing, and biologic enhancement of spinal fusion. Like many residents interested in combining clinical practice with scientific research, Dr. Khan is seeking a collaborative environment that supports research activity in conjunction with a clinical practice. At the CSDP, Dr. Khan was paired with faculty mentor Lars Gilbertson, PhD, director of the Spine Research Laboratory at the Cleveland Clinic. “I am looking forward to asking his advice on research design and methodology—as well as collaborating with him on grant applications,” Dr. Khan said.

The challenge is time
Dr. Brunton, a fourth-year orthopaedic surgery resident at the University of Virginia, is primarily interested in hand surgery; beginning in the summer of 2008, he will be completing a fellowship in hand, upper extremity, and microvascular surgery at the Curtis National Hand Center at Union Memorial Hospital in Baltimore. His specific interest is in tissue engineering applications in hand surgery, such as growth factor augmentation of flexor tendon repairs and evidence-based studies related to upper extremity trauma.

His chairman, his program director, and fellow residents who had previously participated in the CSDP all encouraged Dr. Brunton to apply. Early in his career, Dr. Brunton was leaning toward a career in academics. “I felt that the [CSDP] would help to solidify that commitment and introduce me to potential lifelong clinician-scientist mentors,” he stated.

He will look to his mentor, Edward Diao, MD, who shares his research and clinical interests in hand surgery, for assistance in facilitating his transition from residency training to his first academic appointment. “I hope to draw from [his] experience and avoid the common pitfalls clinician-scientists face early in the transition,” said Dr. Brunton.

“Undoubtedly, the biggest challenge [in becoming a clinician-scientist] will be figuring out how much time I would eventually like to allocate to the four pillars of academic medicine: patient care, teaching efforts, research endeavors, and administrative involvement,” he continued.

Enthusiasm and environment
Dr. Lam believes “support for this career pathway must come from within and without; [one must have] enthusiasm and commitment to acquire additional training and skills, and a supportive environment of colleagues, mentors, and departmental leaders who are devoted to supporting the capacity of the clinician-scientist to advance the academic mission.”

Dr. Lam, a chief resident at the University of California, San Francisco, department of orthopaedic surgery, focuses his clinical work on adult reconstructive and joint preservation surgery, sports medicine, and orthopaedic trauma. Next year, he will enter fellowship training in hand and upper extremity surgery at the Hospital for Special Surgery in New York City, where he will concentrate on the diagnosis and treatment of disorders of the entire upper extremity.

“Clinician-scientists fulfill a unique role in focusing the research enterprise on issues that directly affect patient care,” he stated. Concurrent to his clinical practice, Dr. Lam is conducting cellular-level research as well as studying patient outcome measures. “My laboratory research investigates the molecular and cellular mechanisms of mesenchymal stem cell ontogeny, and the pathophysiology of inflammatory bone loss,” he explained. His clinical research investigates outcome measures based on the patient’s quality of life and relative cost and utility of common orthopaedic procedures.

Dr. Lam, who was also assigned to Dr. Diao because of their shared interest in hand and upper extremity surgery, places great value on the mentors he has had. They serve as “role models [who] effectively stimulate potential young investigators as well as guide the nascent investigator through the barriers to entry and the impediments to success,” he said.

Dr. Lam’s interest in orthopaedics stemmed from athletic injuries sustained in college, which led him to investigate how bones heal. Through various academic mentorships, Dr. Lam pursued studies in bone biology and subsequently investigated the mechanisms of osteoclast adhesion and inflammatory osteolysis before earning a PhD in molecular cell biology while in medical school. The CSDP is another step in his journey.

“The opportunity to develop personal relationships with prominent clinician-scientists, departmental chairpersons, and representatives from funding sources such as the National Institutes of Health (NIH) and the OREF was remarkably empowering,” he stated.

The 2007 program
Formerly under the auspices of the Clinician Scientist Programs Committee, the CSDP is now a program of the AAOS Research Development Committee, chaired by Denis R. Clohisy, MD. The 2007 CSDP program was organized by Constance R. Chu, MD, a recipient of both an NIH R01 career grant and the Kappa Delta Young Investigator Award. The CSDP selection committee included Dr. Diao and John H. Healey, MD, FACS.

Drs. Chu, Healey, and Diao also served as faculty mentors at the 2007 CSDP. The agenda focused on several different topics, including the following: timeline of a clinician-scientist; career training; the importance of establishing a mentor in the early stages of a career; grant writing and peer review; funding opportunities within the NIH, the OREF, and the Department of Defense; negotiating with the department chair; and the chair’s perspective on clinician-scientists. The program concluded with a personal perspective on the busy life of a clinician-scientist, presented by Regis O’Keefe, MD, PhD.

Additional information about the Clinician Scientist Development Program and the 2008 program application and deadline is available at http://www.aaos.org/member/csdp/csdp.asp.

Erin Lynn Ransford is a research coordinator in the AAOS department of government affairs. She can be reached at ransford@aaos.org.