Dr. Jonathan D. Hughes (right), standing next to his research mentor Freddie Fu, MD, presented his research at the AAOS 2018 Annual Meeting in New Orleans.
Courtesy of Jonathan D. Hughes, MD

AAOS Now

Published 5/1/2018
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Jonathan D. Hughes, MD; Peter Mittwede, MD, PhD

Making the Most of Protected Research Time in Residency

Tips for navigating two routes to success
For residents with no prior research experience, making the most of protected research time can be daunting. Residents who are not prepared for or motivated to take part in research endeavors often waste this opportunity.

Our goal through this article is to provide insight and advice based on our experiences and offer tips for a successful research year or rotation.

Jonathan D. Hughes, MD: Away research rotation
I was interested in sports medicine research; however, my residency program offered few, relevant opportunities. Therefore, during my third year of residency, I sought an away research rotation at an academic medical center that offered a plethora of research opportunities. Ultimately, I spent three months at the University of Pittsburgh Medical Center. During that time, I authored numerous manuscripts, book chapters, and review articles.

When choosing an institution for a research rotation, align your personal interests with the projects available at that institution. Focus on programs with dedicated research departments, which have the infrastructure to support multiple studies. These programs may even have unfinished studies in need of completion. Additionally, most of these institutions already accept international research fellows and can incorporate you into their system without difficulty.

I simply examined each institution and identified a mentor whose research interests matched my own. I then sent an introductory email outlining my goals. Doing this outreach well in advance of your rotation gives the institution time to select projects for your participation and add you to institutional review board approvals.

Once I secured the dates and details of my rotation, I emailed my mentor to discuss possible projects. Although it was months before my rotation, my mentor had many ideas on projects he wanted to start and others partially completed by the fellows. This lead time enabled me to gather articles and study the information in advance. I also used the time to update my Collaborative Institutional Training Initiative training, complete the necessary institutional paperwork, and obtain tools such as reference managers (eg, Mendeley or Endnote) and statistical software (eg, SPSS or similar programs).

Approach a research rotation with adaptability and motivation. Each institution has a unique research perspective and its own system for success. No matter your prior research experience, adapting to the institution’s methods will streamline your productivity. Most of the senior staff have published many articles and are adept at producing quality research efficiently. Utilize this environment as a learning opportunity.

Additionally, approach the rotation with enthusiasm. Take on extra work and stay long hours. Attend all resident and fellow lectures and research meetings. This rotation should not be used as a vacation, but rather a time to learn from more experienced researchers on your topic of interest. Make sure to complete all work on time and take responsibility and accountability for your projects.

Residents, fellows, and research fellows are all great resources. Reach out to them for advice or offer to help them with their projects. Most clinical residents and fellows will gladly accept assistance from those who have more time to dedicate to research. Additionally, they are great resources for institution-specific queries, such as who to contact for data assistance, access to photos, and funds for manuscript submission. Also, once your rotation is complete, these individuals can assist with any unfinished projects, especially with data collection and interpretation, as you no longer can view raw data.

Once you’ve completed your rotation, make sure to keep in touch with the institution, particularly with respect to ongoing projects. Make deadlines for yourself and coauthors to ensure timely completion of the projects, or leave detailed instructions for whomever is taking over your project. Apply to regional and national conferences to gain exposure—not only for yourself, but also the institution. Lastly, take the lead role in preparing and submitting manuscripts for each study, as it may take months to years before a manuscript is published.

Peter Mittwede, MD, PhD: Research year
Many people told me that I did not need to pursue a research-track residency program. Coming out of a dual-degree program and having earned a terminal degree in a basic science field, I often heard comments like the following: Why put off earning a real salary? Was your prior research training not adequate? Have you not suffered enough already?

As it turned out, I’m currently in the six-year Clinician Scientist Training Program at the University of Pittsburgh Medical Center, and I could not be happier with my decision. My goal is to become a clinician-scientist at an academic medical center. I’d like to have a busy clinical practice (likely in orthopaedic trauma) and still do quality research. I want to collaborate with PhD researchers and, if I am fortunate, have my own lab. Six-year programs offer those interested in pursuing a career in academics the necessary protected time to gain skills and knowledge in basic science and/or clinical research and to improve manuscript- and grant-writing skills.

Setting goals prior to your research year is critically important. Whether you choose to be in a six-year program or simply matched into one based on the luck of the draw, you would be wise to take full advantage of it. That year can certainly help you or be detrimental if you are not productive.

Do you want to publish as much as possible? Get a research grant? Acquire a tangible skill set? Study more than you have in the past? Each person approaches a research year differently based on career aspirations, but it is a good idea to set goals ahead of time and to fight the tendency to view the year as a vacation, which it certainly is not. One year passes quickly, and while one of the great things about research is a more flexible schedule, it should still be a rigorous year.

Ideally, one’s clinical and research interests will align. While in medical school and early in residency, you may have no choice but to publish random and unrelated papers and book chapters. But as early as possible, you should attempt to find a niche and publish primarily in that realm. People should be able to search for your name in PubMed and identify your research expertise and clinical interest. Although publishing papers in every orthopaedic subspecialty may help boost your numbers, the quantity-over-quality approach is a mistake to which many naïve trainees fall prey.

If you are in a basic science lab for your research year, focus on one to three quality projects and try to see them through to completion. If you are performing clinical research, you can potentially be involved with more projects simultaneously, but the same principle applies. If you take on too many projects either within or outside of the lab, you run the risk of not being effective with any of them. It goes without saying that you must devote a significant amount of time to your projects if you want to be productive. To be an asset in the lab, it is important to understand your skill set and to use it, but you should also be willing to learn a few new skills during the year.

Many programs require residents to have some clinical responsibilities during their research years. Although these activities take away from time in the lab, it is helpful to maintain a clinical mindset. In my program, we take one 24-hour call each month, and we are encouraged to attend trauma conference each weekday. This helps me keep a relatively strict schedule, and makes overall productivity easier to maintain. The research year should also provide adequate time to study and expand your orthopaedic knowledge base.

Conclusion
Protected research time in orthopaedic residency, whether it is at another institution or in your home program, can be extremely beneficial for academic productivity. However, without a proper approach, the time can be wasted. Thus, it is essential to take full advantage of your protected research time by planning ahead, identifying mentors, setting goals, working hard, and focusing on the projects that matter.

Jonathan D. Hughes, MD, is a PGY-4 resident at Baylor Scott and White Health in Temple, Texas, and will attend the University of Pittsburgh for a sports medicine fellowship in 2019-2020.

Peter Mittwede, MD, PhD, is a PGY-2 resident in the clinician scientist training program at the University of Pittsburgh Medical Center. He is planning to pursue an orthopaedic trauma fellowship. His current research involves studying the mechanisms of heterotopic ossification in a mouse blast model.