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AAOS Now

Published 5/1/2011
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Daniel J. Stinner, MD; Brendan D. Masini, MD

Adding more to your plate

A resident perspective on research

Evidence-based medicine is important to orthopaedics not only because it supports improved outcomes for patients, but also because it will be the basis for compensation incentives and may be critical in a litigation scenario. Being part of the research process that leads to evidence-based treatment protocols should be important to surgeons and residents alike.

In a recent study evaluating factors influencing resident research, only 42 percent of respondents said that they were likely to do research as part of their professional careers, although 99 percent of residents thought research was important. Thirty percent of residents were not interested in doing research and another 28 percent were undecided. For many orthopaedic residents, doing a graduation research assignment may be more stress provoking than preparing for board exams. As a result, many may shy away from pursuing research throughout their careers.

Why should residents do research?
Conducting research is more than just a graduation requirement. It also offers both immediate and long-term tangible benefits, beginning with the opportunity to present results at regional or national meetings.

Meetings can be an orthopaedic Disneyland, giving residents access to the latest scientific developments and to thought leaders in the field. Meetings are also an opportunity to network and socialize with colleagues from across the country. What better way to stimulate resident research than to expose residents to others who are doing and enjoying research? The appeal of spending a week away from the grind of residency at a professional meeting has spurred completion of many resident research projects.

As for longer term benefits, research can set a resident apart from the crowd. With so many highly qualified peers contending for fellowships and jobs, the motivated applicant cannot simply rely on good test scores, a quality medical school background, and glowing letters of recommendation. Research is a “tangible” aspect of the application process that demonstrates a resident’s willingness to put in extra time and effort and shows that he or she will be a productive addition to the program.

Finding a project
Lack of research mentorship is a common lament of resident researchers. With limited knowledge of research processes, a resident can quickly become lost and frustrated by the protocols and institutional review board paperwork. A residency research program director can make a big difference. Residents do not need someone to do the work for them, but should have a place to go for answers or help when the process stagnates. Programs with a research track or research fellowship year are at an advantage because peer mentorship or guidance on research issues may be more readily available.

The right kind of project can make the difference between a successful resident researcher and one who fails to present or publish. In many research rotations, residents are asked to “carry the water” or “load the trucks” for a portion of a study before handing off to the next rotating resident. This process not only denies ownership and robs the resident of the benefits of presentation or primary authorship, it is also frustrating and time-consuming.

Residents who find themselves in this situation should not be afraid to say “No.” Working on a project that’s exciting and interesting makes the whole process more enjoyable and is a great motivator.

Although prospective clinical studies are valuable to the profession and provide good experience, they are often too time-consuming and labor-intensive to be practical for residents. The ideal resident project allows the resident to form an idea with a mentor and to take the lead in protocol preparation, project completion, and manuscript writing. Basic science, biomechanical, animal, anatomic, or retrospective research projects are more likely to be completed and valued as a positive resident experience.

Building a team
Coworkers often make the difference between success and failure in research pursuits. Finding a team of residents and faculty who work well together can be very productive. However, this should not be an exclusive arrangement because formation of a research “clique” in a program can be counterproductive.

Any resident with interest and a willingness to work hard should be able to find help with a project. This defines the culture for a successful research program. Residents who have an interest but have not done research need help from someone with a track record of success who is open to a new idea or fresh perspective. Residents with some experience should be prepared to share it with others. Academic center staff members should expect to spend time with resident researchers as a faculty responsibility.

Marshaling resources
Knowing the research resources of a program can also make a difference to the successful resident researcher. Are you the only person who knows how to run the Instron machine? Are you familiar with digital measuring software or have experience with genetics or bench science? Residents who can find a niche and bring their skills to the table will find people who want to use that expertise. Find a protocol to use as a model, or seek help for grant writing or other advanced administrative functions.

Knowing the institution’s capabilities is also important. Designing animal studies without veterinary support or prospective studies without funding support is not efficient. Successful researchers know and use what is available.

Residents who are considering adding more to their plates should consider their goals and be honest with themselves. Those who want to pursue an academic practice, be selected for a competitive fellowship position, or have an interest in advancing the science of orthopaedics will find that residency is a great time to test the waters and see if research is appealing.

Tips for successful resident research

  1. Find a mentor/staff that understands and appreciates your goals/intentions. If you only want to meet your graduation requirement, be clear about that.
  2. Find your question. Ask a focused question that is realistic to answer. Beginning your study before framing the question leads to frustration and failure. The answer to the question should be interesting whether study results are positive or negative.
  3. Know your resources (and those of your organization). Choose your study type based on your funding, lab, and personnel support. If you have no support, ask a question you can answer with a stack of charts and some elbow grease. Build a team with complementary skills. Share the load…and share the credit.
  4. If you do a retrospective study, spend the time up front to develop a good case report form of all the data you intend to collect. You do not want to go back to the charts multiple times to collect additional data.
  5. If you are not interested in academic medicine, avoid prospective studies. They will likely not be finished in time for your graduation and may require extraordinary time and effort. But if you think it is manageable, make it happen.
  6. Keep working on publication. Every paper can be published someplace. Don’t give up and rob yourself of the reward for the hard work you put in.

Daniel J. Stinner, MD, and Brendan D. Masini, MD, are resident members of the AAOS.

Reference:

  1. Ahn J, Donegan DJ, Lawrence TR, Halpern SD, Mehta S. The Future of the Orthopaedic Clinican-Scientist. Part II:Identification of Factors That May Influence Orthopaedic Residents’ Intent to Perform Research. J Bone Joint Surg Am. 2010;92:1041-6.