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How to be a Successful Resident Researcher

CORE Aug 6 2008. How to be a Successful Resident Researcher. Achilleas Thoma , MD, MSc , FRCSC Division of Plastic Surgery Surgical Outcomes Research Centre Department of Clinical Epidemiology and Biostatistics. Learning Objectives. The process of pairing with a supervisor

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How to be a Successful Resident Researcher

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  1. CORE Aug 6 2008 How to be a Successful Resident Researcher AchilleasThoma, MD, MSc, FRCSC Division of Plastic Surgery Surgical Outcomes Research Centre Department of Clinical Epidemiology and Biostatistics

  2. Learning Objectives • The process of pairing with a supervisor • How to start your research project • Determining a timeline for project completion • Tips that help keep things on track

  3. Resident Why do Research? • Because it is a requirement for your program • Resident research day is fast approaching and you are expected to present • You want publications to build your CV

  4. Resident Why do Research? • You have the passion to improve your knowledge • You want to apply for a MSc or PhD program through the Clinical Investigator Program or HRM Program • You have the passion for scientific inquiry and to advance your specialty

  5. Resident Types of Residents • “Talkers” • “Doers” Which are YOU?

  6. Resident Resident Research Productivity • “Talkers” have no publications by the time they have completed their residency program • “Doers” will have published at least 1 article / year in their residency program and will have presented their work at their national society meetings

  7. Resident Prerequisites for Success • Passion The emotion of feeling very strongly about a subject • Initiative The ability and tendency to initiate: to start an action and maintain momentum on the project

  8. 1. The Process of Pairing with a Supervisor

  9. 1. Supervisor Finding Your Supervisor • Match your research interests with supervisor expertise • Do some “detective work” on the supervisor • Read the supervisor’s publications and be familiar with his/her work • Ask if she/he available to meet with you after 5 pm / the weekends

  10. 1. Supervisor Expectations for Supervisor • Supervisor is available to meet in the off hours (i.e. after 5pm / weekends) • Supervisor has done some research • Supervisor is willing to provide timely feedback and guidance on the research project • Supervisor is willing to devote the time and energy to assist you

  11. 1. Supervisor Expectations for Resident • Be a “doer” rather than a “talker” • Resident initiates weekly meetings and gives progress reports on his/her research project • Keeps minutes of discussions and action plan after every meeting and gives copy to supervisor • Knows the basics of research designs

  12. Roles of a Supervisor Resources Opportunities Advice Protection 1. Supervisor

  13. Resources Office space and supplies (e.g. photocopying, internet access) Secretarial and administrative support Financial support to attend meetings, conferences, courses Research coordinator support 1. Supervisor

  14. Opportunities Join ongoing research projects Help review manuscripts and grant applications Attend meetings Learn about Research Ethics Review Committees 1. Supervisor

  15. Advice Methodological challenges of project Pros and cons of working with particular collaborators Time management 1. Supervisor

  16. Protection Opportunities to practice presentations and defend your conclusions in a friendly atmosphere, before presenting at a national meeting. 1. Supervisor

  17. 2. How to Start your Research Project

  18. 2. Organizing Research Starting your Research Project • Is the question you are trying to answer in your research project clinically important or trivial? • Distinction between the trivial and important questions is not that easy… the answer lies in scholarship

  19. Reasons to Pursue a Research Question Intervention is novel Intervention consumes large health care resources Controversy on the effectiveness of the novel procedure Large cost difference between 2 prevailing interventions 2. Organizing Research

  20. 2. Organizing Research Starting your Research Project • You have to be familiar with the boundary of knowledge on the subject • To do this you have to first perform a systematic review of the subject (i.e. thorough review of the literature)

  21. 2. Organizing Research Research is an Iterative Process

  22. Support Collaborate with other residents / medical students 2. Organizing Research

  23. Initial Groundwork for Research Question Formulation Plausibility Feasibility Support Resources 2. Organizing Research

  24. Plausibility Is the question answerable? Must have a thorough understanding of the anatomy, biology, physiology and prevalence of the problem 2. Organizing Research

  25. 2. Organizing Research Plausibility Example • It is not plausible to examine the outcomes of reconstruction of the congenitally absent ear in a RCT comparing the Nagata technique with the “genetic engineering method” • The genetic engineering methods are not advanced at this point in time to regenerate an acceptable ear

  26. Feasibility Whether the study design we choose is one that can potentially answer the research question Best study design depends on the question being asked 2. Organizing Research

  27. Feasibility Example Research Question: Is the supramicrosurgical reconstruction with a periumbilical abdominal flap is superior to the deep inferior epigastric perforator (DIEP) flap in breast reconstruction ? Possible barriers: We don’t know how to transfer a flap with a 0.8 mm luminal diameter of the vascular pedicle We don’t have the required instruments QOL scales may not be sensitive enough 2. Organizing Research

  28. Feasibility Choosing a Study Design Simple Studies (i.e. Case series, Cohort) If little is known on the topic, or there are big gaps in knowledge RCT When a novel surgical technique entered the main stream of surgery and challenges a prevailing one 2. Organizing Research

  29. 2. Organizing Research Feasibility Example Research Design: • RCT to determine whether smoking affects the short-term survival of replanted digits Barriers: • Ethically, we cannot randomize patients to either Group A: continue smoking or Group B: non-smoking after replantation of digits. • For questions of harm, appropriate study designs include case-control studies and cohort studies

  30. Feasibility – Example Research Design: RCT comparing the use of intermittent lower extremity pump vs. low molecular heparin in preventing fatal pulmonary embolism in cosmetic abdominoplasty. Possible Barriers: Fatal pulmonary embolism in cosmetic abdominoplasty is a very rare event. As the frequency of the ‘end points” is a critical factor in the sample size calculation, the rarity of the target event means that the investigator will require a sample size measured in thousands of patients! 2. Organizing Research

  31. Resources Financial resources Think of the budget and the details that go with that! Choose a supervisor who has research coordinator support 2. Organizing Research

  32. 2. Organizing Research Forming the Research Question • You have an idea, the necessary support and resources now you need to transform your research idea into a well built clinical question

  33. 2. Organizing Research Background Questions • Ask for general knowledge about a surgery problem • Have two essential components: • A question root (who, what, where, when, how, why) with a verb • A disorder, or an aspect of a disorder i.e. What complications can occur with the ECTR?

  34. 2. Organizing Research Foreground Questions • Ask for specific knowledge about managing patients with a surgery problem 5 essential components: Patient or problem Intervention Comparison intervention (if relevant) Outcomes Time

  35. 2. Organizing Research Well Built Clinical Question • Population (patient) • Intervention • Comparison (this is optional) • Outcome • Time Horizon

  36. 2. Organizing Research Population (Patients) • How would I describe a group of patients similar to mine? • Be brief and precise i.e. All patients with clinical evidence of carpal tunnel syndrome confirmed with EMG and nerve conduction study

  37. 2. Organizing Research Intervention • Which main intervention, prognostic factor or exposure am I considering? • Be specific i.e. In ECTR, the Agee or the Chow technique or extrabursal or intrabursal

  38. 2. Organizing Research Comparative Intervention • What is the main alternative to compare with the intervention? • Be specific i.e. In OCTR, short incisions and long incisions, as these incisions allow one to visualize the median nerve

  39. 2. Organizing Research Outcome • What can I hope to accomplish, measure, improve or affect? • Be specific i.e. • Pain control • Return to work, ADL • Improve Quality of Life (QOL) • Quality Adjusted Life Years (QALYs)

  40. 2. Organizing Research Outcomes • How will you measure them? • Who will measure them (think of bias introduction) • How often will you measure them?

  41. 2. Organizing Research Time Horizon • Appropriate time to measure outcome • 1 month post-op • 6 months post-op • 1 year post-op • Long term >5 years • For the patient’s life? • Short, intermediate, long term follow-up

  42. 2. Organizing Research Time Horizon Example: • Population --- chronic osteomyelitis of tibia patients • Intervention ---free muscle flap • Comparison --- free cutaneous flap • Outcome ---no drainage of pus from tibia • Time Horizon --- 2 years

  43. 2. Organizing Research Framing the Clinical Problem

  44. 3. Timeline for Completion

  45. 3. Timeline Research Timeline Formulation of Research Question & Study Protocol Development Patient Recruitment; Data Collection Data Analysis Manuscript Writing Present at Peer-Reviewed Meetings 4 Months 8 Months 1 Month 2 Months

  46. 3. Timeline Time Management • Set a realistic goal for completion! • The onus is on YOU!

  47. Time Management! The most important element of time management for academic success is setting aside time for your project 3. Timeline

  48. 3. Timeline Communication Issues • You have to communicate and negotiate with onsite clinical supervisor ahead of time the time required off your clinical duties to perform your research project • Need clear contract and understanding organized ahead of time

  49. 4. Tips for Success

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