The Pursuit of Scholarship: Why We Should Care About Resident Research

How Research Improves Clinical Care: The Case for Orthopaedic Surgeon Research Leadership and Collaboration: AOA Critical Issues Symposium

ABSTRACT

Improving the performance and impact of orthopaedic research is a critical leadership challenge. Musculoskeletal (MSK) conditions are a leading cause of disability worldwide, for which research investment and performance lags far behind the burden of disease. In the United States, MSK disorders account for the highest health care costs, have increased in incidence at the fastest rate, and exceed the combined costs of cardiovascular diseases and neoplasms. Despite the cost to society, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), with primary responsibility for MSK research, receives <1.4% of the funds allocated to the National Institutes of Health (NIH). Although orthopaedic surgeons are leading providers of MSK clinical care, the dearth of orthopaedic clinician-scientists also greatly reduces representation of MSK scientific and clinical expertise among academic and scientific leaders. The goals of this symposium were to highlight the critical need for greater prioritization and investment in orthopaedic research and to engage orthopaedic leaders in addressing these needs. Compelling stories of research success from 3 orthopaedic chairs were featured to highlight how orthopaedic surgeon leadership in bench-to-bedside research substantially advances MSK clinical care. Seminar participants also emphasized the need to improve evidence-based clinical practice for which multicenter prospective cohort and registry studies represent opportunities for broader involvement. Prioritization of orthopaedic clinician-scientist development and formation of multidisciplinary partnerships with basic and translational scientists were emphasized as critical needs to advance MSK health. It is critical for orthopaedic chairs to "be invested in" and to "invest in" the success of orthopaedic research. This investment includes developing a professional climate that values research achievement and collaboration as well as implementing strategies to support and sustain research success. Finally, orthopaedic leaders need to advocate for federal research funding to be proportional to the economic burden of disease for which MSK conditions carry the highest current and projected costs. With health-care costs accounting for nearly one-fifth of the U.S. economy, increasing the investment in orthopaedic research to reduce the prevalence, disability, and morbidity from MSK disease needs to be a top orthopaedic and national leadership priority.

Beyond Accreditation Council for Graduate Medical Education Required Scholarship: The Academic Journey of Plastic Surgery Residents

INTRODUCTION

Research productivity is an important part of required Accreditation Council for Graduate Medical Education scholarship during residency training and critical to trainees who intend to pursue careers in academia. This study aims to determine plastic surgery residents' experiences with and attitudes toward research.

METHODS

Accredited independent (52) and integrated (86) plastic surgery program websites were manually searched for currently active residents' names and email addresses. Identified residents were emailed a survey consisting of 25 questions through Research Electronic Data Capture.

RESULTS

A total of 45 plastic surgery residents responded to the survey request (14.6% response rate). Respondents were 57% female and 43% male, with an average age of 30.7 y. At the time of survey participation, 95% of surgery residents were involved in research endeavors, voluntarily or as part of their residency training. Of the respondents, 13 (32%) previously participated in a research fellowship compared to 28 (68%) respondents who did not. Interestingly, respondents who completed fellowships were 2.84 times (95% confidence interval: 0.52-15.38, P = 0.2269) more likely to intend continuing research endeavors after residency. Participants were most in agreement with statements suggesting their research fellowship benefitted their application in the plastic surgery match process (4 [interquartile range (IQR): 4, 4]), improved their ability to conduct research (4 [IQR: 4, 4]), and helped to better understand medical literature (4 [IQR: 3, 4]).

CONCLUSIONS

Plastic surgery programs' robust research emphasis has a favorable translation into residents' self-perceived understanding of medical literature and clinical knowledge.

The Importance of Engaging in Scientific Research during Medical Training

Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.

Are resident research projects correlated to future subspecialty choice in orthopaedic surgery? A ten-year retrospective review of a single centre's experience

AIM

To determine (1) frequency of resident research projects being in the same orthopaedic subspecialty that they ultimately choose for fellowship and practice; (2) percentage of research projects that were published.

METHODS

Resident Thesis Day programs were independently assessed by two reviewers from 2010 to 2020. Reviewers classified projects based on orthopaedic subspecialty: Spine, Joints, Trauma, Hand, Foot and Ankle, Sports, Pediatrics, Oncology, and Shoulder Elbow. Presenting residents' fellowship subspecialty, current practice specialty, and geographic state of current practice were collected using internet searches. Correlation of residents who completed a thesis day project in the same subspecialty as their fellowship and current practice was calculated.

RESULTS

A total of 81 resident physicians, 11 (13.6%) female, were included. In the entire cohort, 50.6% did a thesis day project in a different field than their current or projected subspecialty. Of those who completed, or are currently completing fellowship, 33 (52.4%) did their thesis day project in the same subspecialty as their fellowship. Of the current residents who have matched into fellowship, 46.7% did a thesis day project in the same subspecialty. A total of 51 (63.0%) projects were published.

CONCLUSION

The majority of resident research projects were published, and about 50% of orthopaedic residents went on to complete a fellowship and practice in the same subspecialty as their research project. As residents often spend a considerable amount of time and effort on their projects, these findings may help tailor resident education and research curriculums to focus more on research principles than specific orthopedic content.

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.

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.

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.