James W. Woodall Jr., MD, PhD, balances research with clinical responsibilities at the University of Mississippi Medical Center. Courtesy James W. Woodall Jr

AAOS Now

Published 1/1/2012
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James W. Woodall Jr, MD, PhD

Doctor, Doctor…

Combining medicine and research to better serve patients

Since May 22, 2009, I’m frequently greeted by faculty and fellow residents at the University of Mississippi Medical Center (UMC) as the “doctor doctor.” I was an intern on the trauma service and was excused after morning rounds that Friday to receive my PhD diploma during graduation ceremonies held that day.

The opportunity to earn a PhD while still completing my medical studies was made possible by a vision held by Robert A. McGuire Jr, MD, orthopaedic surgery residency chairman and program director at UMC. Dr. McGuire wanted to create a program committed to developing orthopaedic clinician-scientists.

More than 7 years ago, Dr. McGuire built the framework for the research program at the University of Mississippi. He envisioned a program where residents would not only conduct research under the guidance of a faculty mentor, but also receive formal training in research methodology.

A 7-year pathway
To realize this goal, Dr. McGuire met with the director and dean of the graduate school to discuss enrolling the research resident in graduate courses so that the resident could complete the requirements for a master’s degree. As their discussions evolved, they realized that a highly motivated resident could complete the required coursework toward eligibility for the PhD candidacy exam. The opportunity to build a solid foundation in research principles and earn an additional degree makes this 7-year clinician-scientist pathway unique among orthopaedic residencies that offer a research component.

The program is now in its eighth year, and four residents have obtained PhDs. The first graduate from the program is now enrolled in a foot and ankle fellowship with a major research direction. The success of the program can be attributed to the tremendous support from the department, our laboratory mentor Michelle Tucci, PhD, and the excellent collaboration between the orthopaedic residency program and the graduate school.

I believe this model provides an excellent opportunity for aspiring orthopaedic clinician-scientists to build a solid foundation in both arenas. My dissertation, for example, focused on the cellular effects of platelet-rich plasma (PRP) on macrophage cells during the inflammatory phase of healing. The formal education in study design and execution of a dissertation project made me begin to think and plan more like a scientist. The opportunity to answer some of the basic science questions surrounding a new treatment like PRP has been incredible.

That type of translational research—from the bench to the bedside—is the real goal of the orthopaedic clinician-scientist program. Combining the scientific approach with the clinical experiences of residency training enhances one’s ability to approach difficult clinical questions in a way that will ultimately benefit patients.

The need to nurture
Although the concept of fostering more orthopaedic clinician-scientists has been endorsed by both clinicians and scientists, finding ways to promote and nurture individuals on this dual pathway has been difficult. The goal of the first Orthopaedic Research Society (ORS)/AAOS Orthopaedic Clinician-Scientist Steering Committee, created in March 2000, was to identify and address obstacles to the development of clinician-scientists. Among the major barriers identified by the committee were the following:

  • a lack of mentors
  • a lack of nurturing environments
  • a lack of financial support for additional training
  • peer pressure to share clinical responsibilities

With support from the AAOS and ORS, this task force has continued to develop strategies to overcome these obstacles and encourage the development of young clinician-scientists. For example the Clinician-Scientist Development Program (CSDP) enables residents, fellowship participants, and junior faculty to learn about collaborative techniques, receive grant writing guidance, and develop mentoring relationships (See “Advancing Orthopaedic Surgery through Science,”). In recent years, webinars and exhibits at the AAOS Annual Meeting have become part of the outreach program.

Changes in the U.S. healthcare system are placing increased responsibility on the physician to provide evidence-based support for various treatments and procedures. In this environment, the continued decline in the number of orthopaedic clinician-scientists is of great concern. Hopefully, programs like the one at UMC will help reverse this trend—not only by graduating “doctor doctors” like myself, but also by providing an example for other programs to follow.

James W. Woodall Jr, MD, PhD, is a PGY-4 orthopaedic resident at the University of Mississippi Medical Center. He can be reached at jwoodall@orthopedics.umsmed.edu