For the orthopaedic surgery residents at New York’s Hospital for Special Surgery (HSS), conducting research is not an option.
It’s a requirement.
“Our mission is to train the next group of orthopaedic leaders, and research is an integral part of that,” explained HSS Orthopaedic Residency Program Director Mathias P.G. Bostrom, MD.
A clinician scientist himself, Dr. Bostrom acknowledged that only some of his residents will go on to make research a part of their careers. What matters, he said, is that all HSS residents gain a deep understanding of the process. From creating a hypothesis to developing the research methodology, from writing for publication to applying for financial support, HSS residents learn the essential roles research plays in continually improving orthopaedic treatment and patient care.
OREF as a teaching tool
Applying for orthopaedic research grant support can be particularly daunting for new researchers, but it can also serve as an invaluable teaching tool. That is why HSS requires all residents not only to design a research project, but also to seek funding for it through the Orthopaedic Research and Education Foundation (OREF).
Why OREF in particular?
“It’s the gold standard for resident grants,” said Dr. Bostrom. “It’s well-structured, comprehensive, demanding, and it has a very good peer-review process.”
Residents must begin thinking about research topics in their first year and develop a specific question in their third year. By the following year, residents must submit a grant application to OREF. They must also present a paper on their research in their final year.
“At HSS, resident research output is tracked for 6 total years (1 year after program completion). During that time, the median resident publication rate is eight. “I don’t think there’s another orthopaedic residency program in the country that comes close to that,” Dr. Bostrom said.
Residents have a great deal of freedom in choosing their research topic, Dr. Bostrom said. Some of those topics, particularly clinical studies using large databases or animal studies, are strong enough to receive the nod from OREF. Even if residents don’t receive funding, Dr. Bostrom said, the review process instructs residents on how to improve on their work.
OREF and HSS have shared a special relationship for six decades. The hospital, established in 1863 to specialize in musculoskeletal training and care, was also the birthplace of OREF, which was created to provide a way for those in the orthopaedic field to support research as a scientific basis for more effective treatment and better patient care.
Dr. Bostrom isn’t the only faculty member who believes in the importance of supporting research. Led by Thomas P. Sculco, MD, surgeon-in-chief emeritus and newly elected OREF trustee, the entire HSS orthopaedic surgery faculty has supported the OREF Annual Fund at the Order of Merit level (contributions of $1,000 or more) for the past 17 years.
OREF served as a teaching tool for Dr. Bostrom while he was still a resident. His first grant application was denied, but the review process helped him tremendously.
“It was the first grant I had ever put together and it was good, but it wasn’t very good,” he recalled. “OREF helped me tighten up the science.”
That feedback eventually led to an OREF Career Development Award (now called the OREF Career Development Grant) in 2008. The award, which encourages a commitment to scientific research in orthopaedic surgery, provided Dr. Bostrom with an annual stipend of $75,000 for 3 years.
Dr. Bostrom said the award was pivotal in ensuring the continuation of his study into how to improve formation of cancellous bone, the spongy bone that becomes compromised with age and the site of most osteoporotic fractures. His research involved developing an animal model of loading to study how to enhance in vivo cancellous bone formation. He said the data he developed during those 3 years led to receiving larger grants from the National Institutes of Health (NIH).
“I couldn’t have done it without OREF,” said Dr. Bostrom.
OREF’s greatest strength, he said, is its mission to ensure that junior- to mid-level scientists have the time and financial support to investigate deeply into research that will eventually benefit the entire orthopaedic profession.
“Continued innovation in technology and ideas will drive the clinical success of the field,” Dr. Bostrom said. “Supporting OREF is an investment in the future.”
Like many clinician scientists, Dr. Bostrom relishes his time in the lab.
“I love the research process. I love thinking about the questions and designing the experiments,” he said. “And I love ultimately understanding how the experiments I design can have some impact on improving patient care.”
This love for research developed while Dr. Bostrom was still in college, working for the NIH during summer vacations.
“There were clinician scientists around me who were so enthusiastic about being able to do research and also take care of patients at the same time,” Dr. Bostrom said.
Now, Dr. Bostrom is himself an enthusiastic mentor for HSS residents as they begin their own orthopaedic research journey. He said his passion for research stems not only from his personal experience, but also from his responsibility as the HSS program director to think strategically about how best to prepare his residents to become future leaders in the orthopaedic profession.
Without orthopaedic research, Dr. Bostrom said, “the field will not move forward. And investing in leaders will move the field forward.”
Lisa Applegate is a contributing writer for OREF.
Editor’s Note: This is the second of a two-part series on the relationship between OREF and HSS. The first article appeared in the June 2014 issue of AAOS Now.