Perspective: Integrating research into surgical residency education: lessons learned from orthopaedic surgery

Correlation between research productivity during and after orthopaedic surgery training

Background

Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.

Methods

Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.

Results

As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, P < 0.001. The range of publication post-training was 0-124 vs. 0-30 during training. Pearson correlation between the two groups resulted in a value of 0.654, P < 0.001.

Conclusion

Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.

The gender role in the publishing of Authorships in high-impact orthopedic journals

To evidence the existence of a gender gap in the orthopedic scientific literature by including also differences between some specific orthopedic surgery specialities, such as hands and feet. Then, we also considered gender role in the Authorship linked with the economic wealth of each country belonging to each Author. The gender of the first Authors of journals on orthopedics and sports medicine indexing in the Scopus database with the highest impact factor (IF) related to the year 2019, for the period from January 1, 2015, to December 31, 2020, were considered. A total of 11 journals were considered, including a total of 5474 articles, 1087 (19.86%) had a woman as the first Author and 4387 (80.14%) a man. During the studied period, the trend seems to be the same (p = 0.906): Men were significantly more producing than women in the orthopedic field both by considering the topic of the journal (p = .003), all the most impacted orthopedic journals (p < 0.001) and economies (p < 0.001). There was therefore a strong significance: In the orthopedic field, there were significantly more male researchers who presented their first name in scientific publications compared to females in all orthopedic subspecialties. The economically poorer countries published less and the role of women became almost absent.

Trends in Integrated Plastic Surgery Applicant, Resident, and Junior Attending Research Productivity

INTRODUCTION

Research productivity is critical for matching into integrated plastic surgery residency. This study will identify how pre and intraresidency research productivity correlate with resident/junior attending productivity.

MATERIALS AND METHODS

Retrospective review from 2006 to 2015 issues of the American Board of Plastic Surgery's Annual Newsletter to Diplomates was performed to identify newly board certified plastic surgeons. Only surgeons from US medical schools matching directly into integrated programs were included. Residency type/length, graduation year from medical school, and publication counts were recorded for each surgeon. Publications were categorized as preresidency, intraresidency, and junior attending (6 y post residency/fellowship training).

RESULTS

Six hundred fifty-five integrated plastic surgery graduates were analyzed. The median number of total publications (preresidency, intraresidency, and junior attending) was 4 (interquartile range [IQR], 1 to 10). Linear regression revealed negligible correlation between preresidency and junior attending publications (r = 0.019, P = 0.002). Total publications and increasing graduation y had a significant correlation of 0.89 (P < 0.001). Graduates of fellowships had significantly increased median total publications compared to those without fellowships (7 IQR, 3 to 18 versus 3 IQR, 1 to 7, respectively, P < 0.001). Dedicated research years during residency were associated with significant (P < 0.001) increases in median total and junior attending publications. Total publications ranged from 3 (IQR, 1 to 6) to 8 (IQR, 7 to 18) for those who completed 5- and 8-y residencies, respectively.

CONCLUSIONS

Increased preresidency research productivity is not strongly associated with increased junior attending productivity in integrated plastic surgery. Better markers are completing dedicated research years in residency or fellowship after residency.

Research activities and critical appraisal skills among Saudi orthopedic residents

BACKGROUND

Medical research is a central part of any residency training. In view of the new Saudi orthopedic committee promotion regulation that mandates each resident to participate in a research project, the challenges that stand in the way of completion of substantial research within surgical residency must be investigated. The aim of this study was to assess the practice, attitudes, perception, and limitations associated with research among residents in the Saudi orthopedic program in the central region.

METHODS

A cross-sectional study was conducted between June and July 2020 using an online-based survey. The total number of study participants was 128 orthopedic residents out of the 191 residents enrolled in the central region program. Data were analyzed, and descriptive statistics in the form of frequency and percentage were determined, analytical tests were performed with P < 0.05 being statistically significant.

RESULTS

Most residents (95 %) participated in a research project during residency. Most projects (53.10 %) were case reports followed by retrospective studies (48.40 %). The majority (79.70 %) did not attend a research methods course during residency. Experience in research differed significantly (P < 0.05) by age, residency year, and center. The mean involvement score was significantly higher among males at 3 (± 1) than among females at 2 (± 0) (P < 0.001). Only 40.60 % have access to orthopedic journals, and the same percentage (40.60 %) knew how to Critique original articles. There was a statistically significant difference in the accessibility score according to the training center. Lack of faculty support and mentorship were the main barriers to medical research at 62.50 and 39.10 %, respectively. A total of 68.80 % reported that funding was not available through their institutes.

CONCLUSIONS

In Saudi Arabia, the level of meaningful clinical research and publications by orthopedic residents is still low. The results of this study should be taken into consideration before the implementation of the new promotion criteria in the centers under the umbrella of Saudi orthopedic committee.

Significance of research in a surgeon-scientist's career - A view from Japan

Reflections of academic pediatric surgery in Japan are shared by the authors. As in most areas of surgical practice committement and life long dedication are emphasized as the key(s) to success. An enquiring mind is always an advantage.

Academic productivity and obstacles encountered during residency training: A survey among residents in orthopedics and traumatology programs in Turkey

OBJECTIVE

This study aimed to investigate the academic productivity of and the obstacles encountered by orthopedic residents in Turkey.

METHODS

Overall, 220 orthopedic specialists who were registered in the Ministry of Health and had started orthopedic residency between 2009 and 2010 were invited to participate in a survey through e-mail. The survey comprised a total of 19 questions to evaluate the academic works conducted and obstacles encountered during residency. Academic work was defined as an article published in the peer-reviewed journals as well as an oral or poster presentation at a national or international congress. Case reports, letters to the editor, and technical notes were excluded.

RESULTS

Data were obtained from 116 respondents who completed the survey. In peer-reviewed journals in Science Citation Index (SCI) or SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.09 and 0.73, respectively. In peer-reviewed journals other than those in SCI and SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.37 and 1, respectively. The mean number of oral and poster presentations per resident at national and international congresses was 2.63 and 4.67, respectively. No significant difference in the number of academic works was noted between the regions and institutions (p>0.05). A significant positive correlation was observed between the number of associate professors and assistant professors in the clinic and the total number of academic works (article plus presentation) (p<0.01 and p=0.017, respectively). Regarding encouragement and support to academic works, 6.9% of the respondents found the clinic to be excellent, 20.7% good, 24.1% moderate, and 48.3% bad. No significant difference in encouragement and support to academic works was noted among the institutions (p=0.115). The most common obstacle encountered in conducting academic works was long working hours (74.5%).

CONCLUSION

Regardless of the region and institution, the participation of orthopedic residents in academic works is low in Turkey. Several obstacles were encountered in conducting academic works, with the most common being long working hours.

LEVEL OF EVIDENCE

Level IV, Diagnostic study.

Investing in Pediatric Surgical Research to Advance Universal Health Coverage for Children in Nigeria

About 1.7 billion children and adolescents most of whom are in low- and middle-income countries lack access to safe and affordable surgical and anesthesia care when needed. 43% of Nigeria's population of 199 million are below the age of 15 years. In 2015, Nigeria had a pediatric surgeon workforce deficit of 693 for children <15 years. While threats and constraints to achieving universal health coverage in Nigeria have been highlighted, the role of research is often not included. Over the years, there has been a slow but progressive increase in pediatric surgical workforce and research output, both locally and with international collaborations, and in trainee involvement in research as lead authors. There has unfortunately been a challenge with translation of research findings, outcomes, and recommendations into actions. Despite the various challenges mitigating against pediatric surgery research, efforts must be committed to developing and implementing innovative approaches to address the problems and challenges, as well as implementing quality improvement programs and deploying technology to advance children's care. It is hoped that inclusion of children's surgery in the National Surgical, Obstetrics, Anaesthesia, and Nursing Plan would strengthen pediatric surgical research in Nigeria.

Structure and evaluation of a residency research program in a university hospital

BACKGROUND

Most academic medical institutions lack a structured program that provides residents with an in-depth research training. The objectives of this paper are to describe a comprehensive residency research program at a university hospital, and to assess the pre- post-self-assessment of research capabilities of resident for the evaluation of the program.

METHODS

The residency research program (RRP) was implemented in 2011 as an essential component of the residency program at the American University of Beirut Medical Center. Categorical residents are required to carry out a research project and go through all the steps of the research process from identifying a topic to writing a manuscript. As for evaluating the program, data were collected from residents who graduated between 2014 and 2016 using a questionnaire, which included the overall evaluation of the program, self-assessment on research-related tasks pre- and post- joining the program, as well as general recommendations. The mean scores on the five-point Likert scale were transformed into percentages (0-100%). The average was calculated and the difference in the means was reported.

RESULTS

Overall, 103 residents from the different clinical departments were included in this study. Residents' self-assessment showed a 19.3% improvement in research-related tasks before and after completion of the RRP (P < 0.0001). Most of the residents have either published or are in the process of publishing their projects (34 and 55.3%, respectively). Time management was the most reported challenge. Generally, the program was evaluated positively.

CONCLUSION

The RRP is a unique, well-structured program, encompassing residents from various clinical departments, which enhances residents' research capabilities.

Research-Track Residency Programs in Orthopaedic Surgery: A Survey of Program Directors and Recent Graduates

BACKGROUND

The importance of research in resident education has been emphasized in the orthopaedic surgery community, and a number of residency programs have incorporated a year or more of protected research time into their training. However, limited information exists as to what programs are looking for in applicants to research-track residency programs or the perceived benefits of completing such a program.

METHODS

We identified orthopaedic surgery programs that have tracks involving at least 1 year of protected research time and sent surveys to their program directors and to the 2012 through 2016 research-track graduates.

RESULTS

Twenty-three programs with research tracks were identified, and 19 program directors (83%) responded to the survey. The survey revealed that only 2 (11%) of these program directors were willing to accept lower scores and grades among applicants to their research track compared with their primary clinical (categorical) track. While most of the program directors (14 [74%]) preferred that applicants have an interest in academics, only a few (3 [16%]) considered it a failure if their research-track residents did not pursue academic careers. We obtained the e-mail addresses of 82 research-track graduates, and 66 (80%) responded to the survey. The survey revealed that those who went into academic careers were more likely than those who went into private practice to view completing a research track as beneficial for fellowship (73% versus 35%, respectively) and job (73% versus 22%, respectively) applications, believed that the income lost from the additional year of residency would be compensated for by opportunities gained from the research year (50% versus 17%, respectively), and said that they would pursue a research-track residency if they had to do it over again (81% versus 39%, respectively; all p values <0.05).

CONCLUSIONS

The majority of program directors preferred that applicants to their research-track program have an interest in academics, although most did not consider it a failure if their research-track residents entered nonacademic careers. Graduates of research-track residency programs who entered academics more frequently viewed the completion of a research track as being beneficial compared with those who went into private practice.

An Analysis of Research Quality and Productivity at Six Academic Orthopaedic Residencies

OBJECTIVE

It remains largely unknown what factors impact the research productivity of residency programs. We hypothesized that dedicated resident research time would not affect the quantity and quality of a program's peer-reviewed publication within orthopedic residencies. These findings may help programs improve structure their residency programs to maximize core competencies.

DESIGN

Three hundred fifty-nine residents and 240 staff from six different US orthopedic residency programs were analyzed. All publications published by residents and faculty at each program from January 2007 to December 2015 were recorded. SCImago Journal Rankings (SJR) were found for each journal.

RESULTS

There were no significant differences in publications by residents at each program (p > 0.05). Faculty with 10+ years of on staff, had significantly more publications than those with less than 10 years (p < 0.01). Programs with increased resident research time did not consistently produce publications with higher SJR than those without dedicated research time.

CONCLUSIONS

Increased dedicated resident research time did not increase resident publication rates or lead to publications with higher SJR.

Scholarly Success of Orthopaedic Surgeons Participating in the Clinician Scholar Career Development Program

BACKGROUND

A concern exists about the decline in young orthopaedic surgeons pursuing careers as clinician-researchers. One program designed to address this concern is the American Academy of Orthopaedic Surgeons/Orthopaedic Research and Education Foundation/Orthopaedic Research Society (AAOS/OREF/ORS) Clinician Scholar Career Development Program (CSCDP). The aims of this study were to better understand the characteristics of CSCDP participants and how the experience effects involvement in career-impacting opportunities and scholarly activity.

METHODS

This study was a retrospective analysis. CSCDP participants from 2003 to 2014 were recorded, and demographic information was collected. An Internet search was utilized to determine each surgeon's current practice environment. The National Institutes of Health (NIH) Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was used to track NIH funding. The OREF and its web site were used to query OREF grant funding. American Orthopaedic Association (AOA) Traveling Fellowship awardees were recorded from the AOA web site. Specialty-specific traveling fellowship awardee information was collected via organization web sites, and direct-contact, scholarly activity, and impact were determined using the Scopus database Hirsch index (h-index).

RESULTS

Two hundred and thirty-two individuals (229 confirmed current orthopaedic surgeons) participated in the CSCDP. Fifteen (6.6%), 41 (17.9%), 20 (8.7%), and 17 (7.4%) former CSCDP participants have been awarded NIH funding, OREF grant support, AOA Traveling Fellowships, and/or specialty-specific traveling fellowships, respectively. Those involved in any of the career-impactful opportunities post-CSCDP have had higher scholarly activity and impact compared with those who were not involved in the career-impactful opportunities (h-index: 15.9 [standard deviation (SD), 8.1] versus 10.0 [SD, 5.7], p < 0.0001). No scholarly activity and impact differences existed between orthopaedic subspecialties (p = 0.077).

CONCLUSIONS

The CSCDP appears to play an important role in promoting clinician-researcher careers in orthopaedic surgery.

CLINICAL RELEVANCE

The CSCDP must continue to adapt to the surrounding health-care landscape to achieve an even better success rate in creating clinician-researchers who will further advance musculoskeletal health and discovery for the betterment of the patients and the profession.

Can a Clinician-Scientist Training Program Develop Academic Orthopaedic Surgeons? One Program's Thirty-Year Experience

BACKGROUND

Clinician-scientist numbers have been stagnant over the past few decades despite awareness of this trend. Interventions attempting to change this problem have been seemingly ineffective, but research residency positions have shown potential benefit.

OBJECTIVE

We sought to evaluate the effectiveness of a clinician-scientist training program (CSTP) in an academic orthopedic residency in improving academic productivity and increasing interest in academic careers.

METHODS

Resident training records were identified and reviewed for all residents who completed training between 1976 and 2014 (n = 329). There were no designated research residents prior to 1984 (pre-CSTP). Between 1984 and 2005, residents self-selected for the program (CSTP-SS). In 2005, residents were selected by program before residency (CSTP-PS). Residents were also grouped by program participation, research vs. clinical residents (RR vs. CR). Data were collected on academic positions and productivity through Internet-based and PubMed search, as well as direct e-mail or phone contact. Variables were then compared based on the time duration and designation.

RESULTS

Comparing all RR with CR, RR residents were more likely to enter academic practice after training (RR, 34%; CR, 20%; p = 0.0001) and were 4 times more productive based on median publications (RR, 14; CR, 4; p < 0.0001). Furthermore, 42% of RR are still active in research compared to 29% of CR (p = 0.04), but no statistical difference in postgraduate academic productivity identified.

CONCLUSIONS

The CSTP increased academic productivity during residency for the residents and the program. However, this program did not lead to a clear increase in academic productivity after residency and did not result in more trainees choosing a career as clinician-scientists.

Protected Time for Research During Orthopaedic Residency Correlates with an Increased Number of Resident Publications

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) requires orthopaedic residency programs to promote scholarship and research, which manifest differently among programs. We assess the impact of protected research time during orthopaedic residency on the number of resident publications.

METHODS

Rotation schedules and resident names were collected from 125 ACGME-accredited U.S. orthopaedic residency programs. Protected research time was classified as 1 of 3 types: (1) block time, (2) longitudinal time, or (3) no dedicated time. In April 2016, we searched residents in postgraduate year (PGY)-3 to PGY-5 on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published during residency. Each publication's 2015 Thomson Reuters Journal Citation Reports 5-Year Journal Impact Factor and resident first authorship were noted. The number of PubMed identifiers for each program was summed and was divided by the number of residents in PGY-3 to PGY-5, giving a mean number of publications per resident. The relationship between output and program research time was compared using t tests and analysis of variance (ANOVA).

RESULTS

A total of 1,690 residents were included, with an overall mean number (and standard deviation) of 1.2 ± 2.4 publications per resident. Eighty-seven programs reported block time, 14 programs reported longitudinal time, and 24 programs reported no time. There was a significant difference (p = 0.02) in the mean number of publications per resident when compared between programs with protected time (1.1 ± 1.2 publications) and programs with no protected time (0.6 ± 0.5 publication). One-way ANOVA demonstrated a significant mean difference across the 3 groups (p < 0.001), with longitudinal time correlating with significantly greater output at 1.9 ± 1.8 publications than block time at 1.0 ± 1.0 publication or no time at 0.6 ± 0.5 publication, a difference that persisted when adjusted to include only impact factors of >0 and exclude case reports (p = 0.0015).

CONCLUSIONS

Both the presence of and the type of dedicated research time correlate with residents' research productivity; further consideration of protected research time during residency is warranted.

CLINICAL RELEVANCE

This article provides objective data with regard to research strategies in training orthopaedic surgeons.

Protected Resident Research Time Does Not Increase the Quantity or Quality of Residency Program Research Publications: A Comparison of 3 Orthopedic Residencies

INTRODUCTION

The effect of dedicated resident research time in terms of residency program research productivity remains largely unknown. We hypothesize that the quantity and quality of a residency program's peer-reviewed publications (PRPs) increase proportionately with the amount of dedicated research time given to residents.

METHODS

Three residency programs (P1, P2, and P3) were examined. P1 has a mandatory research year for all residents between postgraduate years 3 and 4. P2 has an elective research year for 1 resident between postgraduate years 2 and 3. P3 has no dedicated research time for residents. All publications produced by residents and staff at each program from January 2007 through December were recorded from PUBMED. SCImago Journal Rankings were used as a proxy to measure research quality.

RESULTS

There was no significant difference in the number of publications produced between the institutions on a per-staff (p = 0.27) and per-resident (p = 0.80) basis. There were no residents at P3 who graduated without at least 1 PRP, whereas there were 7 residents from P1 and 8 residents from P2 who graduated without a PRP. There were no significant differences between programs in terms of the SCImago Journal Ranking for the journals containing their publications (p = 0.135).

DISCUSSION

Residency programs with dedicated research time did not produce significantly (p > 0.05) more, or higher quality, PRPs than residencies without dedicated research time. It may be that the quantity and quality of PRPs is related more to faculty engagement, research interest, and mentorship at individual programs rather than the number of residents given dedicated time to complete research.

LEVEL OF EVIDENCE

Level 3.

Biographic Characteristics and Factors Perceived as Affecting Female and Male Careers in Academic Surgery: The Tenured Gender Battle to Make It to the Top

Purpose: Given the high attrition rate in the field of academic surgery, we aimed to characterise the professional and personal situations of female and male academic surgeons as well as to gather data on their respective perceptions of career advancement and work satisfaction. Methods: We conducted a cross-sectional survey in Germany, inviting all identifiable academically highly qualified female surgeons and their male counterparts in a 1:2 ratio to participate. An anonymous 103-item online questionnaire was designed and the data collected between July and September 2014. Results: The questionnaire was sent to 93 female and 200 male surgeons, of whom 63 women (67.7%) and 70 men (35.0%) replied. The average age was 47.5 and 47.1 years, respectively. Respondents identified ‘high degree of expertise', ‘ambition', and ‘clarity of one's professional aims' as important factors affecting professional career development. Both groups felt ‘workload', ‘working hours/shifts', and ‘gender' to be a hindrance, the latter of significantly greater importance to female surgeons. The mean work satisfaction scores were high in both female (69.5%) and male (75.7%) surgeons. The predictors ‘support from superiors' (standardised β coefficient = 0.41) and ‘manual aptitude' (β = 0.41) contributed incrementally to the variance in ‘high degree of work satisfaction' (90-100%) observed for female surgeons. However, childcare provided by ‘kindergarten/crèche/after-school care' had the greatest negative predictive value (β = -1.33). Conclusions: Although there are many parallels, female faculty members experience the culture of academic surgery to some extent differently from their male counterparts, especially when impacted by parenthood and childcare. Faculty development programmes need to develop strategies to improve perceived equality in career opportunities by respecting individuals' requirements as well as offering gender-appropriate career guidance.

An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice

Objectives

Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making.

Materials and Methods

A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns.

Results

A total of 353 surgeons completed the survey. Surgeons achieved consensus on the ‘importance’ of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly.

Conclusion

Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality.

Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130–136. DOI: 10.1302/2046-3758.54.2000578.

GME Concentrations: A Collaborative Interdisciplinary Approach to Learner-Driven Education

BACKGROUND

Graduate medical education (GME) programs may struggle to provide the knowledge, skills, and experiences necessary to meet trainee career interests and goals beyond a clinical focus. Sponsoring institutions can partner with programs to deliver content not included in typical clinical experiences of GME programs.

OBJECTIVE

To perform a needs assessment and to develop, implement, and measure acceptability and feasibility of an institution-wide GME Concentrations curriculum.

METHODS

In response to the needs assessment, GME leadership developed 4 concentrations: (1) Resident-as-Teacher; (2) Patient Safety and Quality Improvement; (3) Law, Ethics, and Health Policy; and (4) Leaders in Medicine. We formed advisory committees that developed curricula for each concentration, including didactics, experiential learning, and individual project mentoring. Participants completed pre- and postassessments. We assessed feasibility and evaluated participant presentations and final projects.

RESULTS

Over the course of 3 years, 91 trainees (of approximately 1000 trainees each year) from 36 GME programs (of 82 accredited programs) have participated in the program. The number of participants has increased each year, and 22 participants have completed the program overall. Cost for each participant is estimated at $500. Participant projects addressed a variety of education and health care areas, including curriculum development, quality improvement, and national needs assessments. Participants reported that their GME Concentrations experience enhanced their training and fostered career interests.

CONCLUSIONS

The GME Concentrations program provides a feasible, institutionally based approach for educating trainees in additional interest areas. Institutional resources are leveraged to provide and customize content important to participants' career interests beyond their specialty.

What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews

BACKGROUND

Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries.

PURPOSE

We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments.

MATERIALS

Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer.

RESULTS

We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research.

CONCLUSIONS

The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.

Strategic career planning for physician-scientists

Building a successful professional career in the physician-scientist realm is rewarding but challenging, especially in the dynamic and competitive environment of today's modern society. This educational review aims to provide readers with five important career development lessons drawn from the business and social science literatures. Lessons 1-3 describe career strategy, with a focus on promoting one's strengths while minimizing fixing one's weaknesses (Lesson 1); effective time management in the pursuit of long-term goals (Lesson 2); and the intellectual flexibility to abandon/modify previously made decisions while embracing emerging opportunities (Lesson 3). Lesson 4 explains how to maximize the alternative benefits of English-language fluency (i.e., functions such as signaling and cognition-enhancing capabilities). Finally, Lesson 5 discusses how to enjoy happiness and stay motivated in a harsh, zero-sum game society.

What makes a "great resident": the resident perspective

Orthopedic surgery residency training is a difficult endeavor, and the selection of residents that will perform well in a rigorous training program is challenging for residency program directors. Even defining a "great" resident is a difficult endeavor. However, there are certain qualities that anecdotally are associated with high-performing residents, which include being trustworthy, hard-working and efficient, self-directed learners, detail-oriented, and personable. These qualities are difficult to teach and are likely learned by an individual during their early years of education and groomed during college and medical school. Individuals possessing these characteristics are more likely to bring a high-level of professionalism to their work as residents and to perform well on objective measures of success in residency such as high OITE scores, good faculty evaluations, and peer-reviewed publications. We discuss the available, but limited, literature on what makes a "great" resident and share the resident perspective on this topic.

A preliminary report on the initiation of a clinical research program in an orthopaedic surgery department: roadmaps and tool kits

OBJECTIVE

A formal research program enhances resident training experience, productivity and hones critical appraisal skills. This initiative sought to investigate if an academic orthopaedic surgery department could implement a clinical research program, with the goal of increasing resident scholarly activity, a requirement of the Resident Review Committee, and achieve a parallel aim of enhancing the research focus of faculty.

DESIGN

A multifaceted intervention including a needs assessment, appropriation of dedicated research staffing, development of tracking tools and policies, and a formalized research curriculum, followed by additional research time for residents was planned and implemented. The impact of all of these efforts is measured with specific outcomes, pre and post implementation.

SETTING

The North Shore-LIJ Orthopaedic Surgery Department is a high volume clinical and education program with 17 fulltime core faculty and 18 residents at 2 tertiary hospitals.

PARTICIPANTS

Residents were the focus of the intervention. The participation of faculty as principal investigators and sponsors was a key component to ensure success.

RESULTS

The following outcomes were observed post intervention: increases in institutionally-required research training for faculty/residents, number of IRB protocols submitted, abstracts submitted to national meetings, percentage of time faculty report they spend on research activities, additional hours allocated to the new Department sponsored research curriculum and an additional research rotation for trainees.

CONCLUSIONS

The official inception of a formalized program (2012) with a structured research process, invigorated faculty and trainees to formulate clinical research inquiries, generate hypotheses, create protocols and design and implement protocols. Structured tools, an experienced clinical research "champion" and commitment from departmental leadership were demonstrated as effective in transforming the focus of a clinical department into one with a nascent clinical research program, with demonstrable outcomes.

Effect of a mandatory research requirement on categorical resident academic productivity in a university-based general surgery residency

BACKGROUND

Our general surgery residency (46 residents, graduating 6 categoricals per year) offers the opportunity for 2 categorical residents at the end of their second year to choose a 2-year research track. Academic productivity for the remaining categorical residents was dependent on personal interest and time investment. To increase academic productivity within the residency, a mandatory research requirement was implemented in July 2010. We sought to examine the effect of this annual individual requirement.

METHODS

The research requirement consisted of several components: a curriculum of monthly research meetings and lectures, assigned faculty to act as research mentors, an online repository of research projects and ideas, statistical support, and a faculty member appointed Director of Research. In July 2010, the requirement was applied to all categorical postgraduate year 1-3 residents and expanded to postgraduate year 1-4 in 2011. The research requirement culminated in an annual research day at the end of the academic year. We compared the number of abstract presentations in local, national, and international meetings between the first 2 years of the research program and the 2 years before it. We also compared the total number of publications between the 2 periods, acknowledging that any differences at this point do not necessarily reflect an effect of the research requirement.

RESULTS

From July 2008 to June 2010 (Period A), there were 18 podium and poster presentations in local, national, and international meetings, and 30 publications in peer-reviewed journals, whereas between July 2010 and June 2012 (Period B), there were 58 presentations and 32 publications. In Period A 9 of 60 (15%) categorical residents had a podium or poster presentation in comparison with Period B when 23 of 58 (40%) categorical residents had a podium or poster presentation (p < 0.01).

CONCLUSION

The institution of a mandatory research requirement resulted in a 3-fold increase in scientific presentations in our surgical residency. We believe that the mandatory nature of the program is a key component to its success. We expect to see an increase in the number of publications as a result of this research requirement in the next several years.

[Compatibility of science and clinical aspects. Between realism and utopia]

The working environment for young residents in orthopedic surgery has changed tremendously over the past 10 years. Due to cumulative clinical requirements and increasing demands on work-life balance research activity has become less attractive. Successful incorporation of research into the career of residents is a challenging project for the future. The young forum of the German Association for Orthopedics and Traumatology (DGOU) provides different approaches to enhance the quality of research and to help young orthopedists and trauma surgeons.

Increasing research capacity in the chiropractic profession: A case study and evaluation of an innovative research program in Norway

OBJECTIVE

The subject of research methods is not commonly covered in continuing professional development (CPD) courses in spite of its emphasis in undergraduate education. This initiative aimed to develop postgraduate research competency and recruit chiropractors to musculoskeletal research.

METHODS

The program was delivered as a university-based program with 20 credits over seven contact weekends covering topics of evidence-based practice, research methods, statistics, ethics, resources, and funding. Students were assessed through assignments showing competency in critical literature review, case report writing, and production of a research protocol as the final assessment. Non-student participation for CPD points was possible. A student evaluation survey was completed after the end of the academic year.

RESULTS

There were 26 participants: 16 as students handing in assignments, 10 as non-student participants for up to 94 CPD points. Three submitted a final protocol and two registered at a university PhD program. A network of research clinics was established for data collection for future multicenter studies.

CONCLUSIONS

The program was well received by the participants and gave them the tools and resources to perform research. The two-level attendance system afforded a basis for setting up a network of research clinics with a fundamental understanding of optimal data collection. This initiative has shown that research skills can be revisited through CPD programs as part of evidence-based lifelong learning.