Scott Boden, MD, FAAOS
Published 4/26/2024
|
Janice Bonsu, MD, MPH
Editor’s note: This interview is a companion piece to the article “Applied Biomechanics Research Offers Numerous Benefits for Orthopaedic Surgery Residents.”
Scott Boden, MD, FAAOS, has been a practicing orthopaedic spine surgeon for 32 years. Now, as chair of the Department of Orthopaedic Surgery at Emory University in Atlanta, he serves as an exemplar of the true meaning of physician-scientist. In his early career, Dr. Boden’s lab pioneered key concepts that enabled the translation of bone morphogenic proteins into clinical use, revolutionizing bone fusion procedures, primarily in spine and trauma. For AAOS Now, he offered advice and wisdom for orthopaedic surgery residents who are interested in pursuing applied biomechanical research.
Dr. Boden’s first foray into applied biomechanics research was as a junior resident. He was preparing for an ankle fracture case and sat in the room as three different attendings offered three very different perspectives on fixation. “As a second-year resident, I was thinking, ‘If there’s this much diversity in what to do, either it doesn’t matter, or we don’t know,’” he recalled. “I started thinking about when you need a syndesmosis screw and why there wasn’t a consensus.” He added, “Whenever you see people do things two or three different ways, ask yourself why and whether you can think of a way to test the concept and see if there is a clear answer.”
His curiosity led him to design a cadaver study examining the biomechanical necessity of a syndesmosis screw in pronation–external rotation fractures. As he explained, “We didn’t have fancy equipment. We had pulleys and a bunch of cadavers. We thought about how the ankle is stressed during ambulation. We serially sectioned different types of ankle fractures and figured out at what point there was enough instability, biomechanically, to warrant a syndesmosis screw.”
According to Dr. Boden, generating ideas for research should be an active exercise, and the best researchers are those who are constantly asking questions. “I’m not someone with a photographic memory, so if I can understand the ‘why,’ then I can get to an answer accurately and reproducibly. Some people just want to know the ‘how,’ and they will do the ‘how’ each time they see the scenario. Good researchers must be naturally inquisitive,” he said. However, although some people are wired to think that way, he does believe these skills can be taught. “I remind residents when I talk [to them] that they’re seeing me at the backend of my career. I never wrote a paper during my college career. My first paper was as a third-year medical student, and I spent a year writing it!”
For a resident with limited time and resources, Dr. Boden noted that biomechanical studies represent a low-barrier option to research engagement. “There are a lot of simple questions that can be answered with biomechanical modeling,” he said. Recalling one of his earlier spine projects, he said, “I began thinking about [cases] when you have enough instability that you have to think about adding a fusion procedure. There were a lot of conversations during that time [about how to handle such cases,] but not a current, well-thought-out model. So, we designed a biomechanical study and did a laminectomy and a series of partial facetectomies. We were investigating whether you take the facet capsule and what it does to the stability of the spine. These questions have direct impact on what you do at work the next Monday morning.”
How does an interested resident get started? “Biomechanical studies are great for residents because they arise from questions that can often be answered in a short amount of time.” He added, “Over time, your research portfolio should change, and you should be willing to take risks in different ways. People who only do database studies should consider mixing it up with imaging studies, biomechanical studies, or helping with a clinical project. Diversity is the key to success as a researcher.”
When designing a research question, Dr. Boden advised, “The best study is where you can ask a question that people would want to know the answer, no matter if its positive, negative, or neutral.” Particularly for residents who have the benefit of a variety of rotations with different attendings, this exposure enables curiosity that can lead to thoughtful projects, Dr. Boden noted.
“I wish there was a way to make people not afraid of research,” he said. “We all like to be really good at what we do, but you have to accept the natural learning curve when you start something new. You don’t have to cure cancer or discover insulin as a resident. Each time you do research, you will get a little better.”
Janice Bonsu, MD, MPH, is a third-year orthopaedic surgery resident at Emory University in Atlanta and a member of the AAOS Now Editorial Board.