Summer program promotes orthopaedics to minority students

“Research does more than advance medical care for patients,” Charles L. Nelson, MD, told participants of the Orthopaedic Summer Internship (OSI) orientation held at AAOS headquarters in May. “It helps providers develop critical thinking skills, enhances opportunities for advancement, and can lead to improvements in other fields.”

Sponsored by the AAOS and Nth Dimensions Educational Solutions, the OSI program is an 8-week summer internship offered to first-year female and minority medical students enrolled in the AAOS, J. Robert Gladden Society, and Ruth Jackson Orthopaedic Society mentoring programs. OSI’s goal is to raise awareness and increase diversity in orthopaedics. During the program, medical students work side by side with orthopaedic surgeon mentors to gain valuable clinical and research experience. The students are then required to present their research at a national scientific meeting.

Dr. Nelson and Gezzer Ortega, MD, a surgical research fellow and former OSI participant, provided students with an overview of the merits and types of research, shared tips for conducting a successful research project, and offered advice for research participation.

Merits of research
In addition to advancing patient care, research provides important personal and societal benefits, said Dr. Nelson.

“On the personal level, research encourages lifelong learning, enables you to refine your critical thinking skills, and may lead you to develop novel solutions for improving the care of your patients,” he told attendees. He added that respected physician researchers often become candidates for leadership positions within the academic medical community.

Research also enables the globalization of ideas, leading to exponential improvements in patient care that benefit societies as a whole, according to Dr. Nelson. Another societal benefit is that research conducted by women and minorities—which the OSI exclusively supports—helps promote diversity on several levels.

“Women and minority orthopaedic researchers serve as role models and leaders, thereby encouraging diversity efforts in other fields,” he said.

Types of research
Research can be classified as either basic science or clinical. “Basic science research, which most people think of as laboratory research, can range from basic understanding of cell biology to translational research that has an immediate impact on patient care,” said Dr. Nelson.

Basic research categories related to orthopaedics include cellular and molecular medicine, tissue engineering, biomechanics, and genetics or genomics.

Clinical research, on the other hand, relates directly to the care of patients. Dr. Nelson explained that the strength of a clinical study’s results is differentiated by levels of evidence. The study’s design can also affect the strength of the evidence.

“Retrospective studies examine data after the fact,” he said. “The problem with retrospective studies is that pertinent data may not have been gathered ahead of time. A prospective study, however, is planned according to a hypothesis—what we think is going to happen. So when we recruit patients, we can collect all the pertinent data needed, thus improving our ability to test our hypothesis and increase the level of evidence.”

Level 1 trials, such as a blinded randomized controlled trial (RCT) or a meta-analysis of several RCTs, represent the highest level of evidence, Dr. Nelson said. Level 5 studies, also known as expert opinion, represent the lowest level of evidence.

“A blinded RCT that is sufficiently powered and in which patients are randomly assigned to receive one of two different treatment options is the purest type of research,” he said. “These studies in orthopaedics, however, are difficult to conduct.”

Tips for success
To ensure that the internship experience is a success, Dr. Ortega stressed that students do their homework, keep the end in mind, and be prepared to work hard.

“Get acquainted with your mentors’ research—find out what journals they are published in and read their articles. This will give you insight into what your mentors are working on,” he said.

“Due to the time constraints of an 8-week program, your mentor will likely assign you to an ongoing research project or to a component of a larger project,” he said. “To familiarize yourself with the subject matter, review the literature on sites such as PubMed, Google Scholar, and Web of Science.”

It’s also very important that students and their mentors communicate their expectations. “Let your mentor know that your goals are to complete a research project, prepare a poster presentation, and, ultimately, get a manuscript published.”

In addition, Dr. Ortega advised the students to have a game plan. “You may be working with other people on your research project—make sure that you know how to contact your collaborators and that each of them understands his or her role.”

Dr. Ortega also recommended that the students start working on their research abstract during the internship. He instructed the students to write the results section of the abstract first, making sure to report the data objectively. “Write the conclusion next, followed by the introduction and study methods,” he advised. “At the end of the internship you’ll have an abstract that you can submit to major scientific meetings and that will serve as the blueprint for your poster and manuscript.”

Additional dos and don’ts
“The OSI is a great opportunity, but with any great opportunity comes great responsibility,” Dr. Nelson reminded the students. In addition to setting goals and establishing expectations with mentors, students must be respectful and courteous to everyone, and protect patients’ privacy as required by law, he said.

Dr. Ortega encouraged the students to communicate regularly with their mentors and stressed the importance of maintaining a professional tone in all written communications, including emails.

“I would send my mentor weekly updates,” he said. “This not only kept him informed, but also enabled me to reflect on my progress from week to week.”

Dr. Ortega emphasized that students need to receive authorization from their mentors before submitting their work for publication, but added that they should not rush to get published.

“Academics come first,” he said. “Continue working on your research project during your second year of medical school and aim for getting your study published during your third year—that way you can list it on your residency applications.”

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org