Why Research?

The first 5 years of practice as an orthopedic sports surgeon are exhilarating, demanding, and full of learning. While honing clinical skills and building patient relationships are paramount, do not underestimate the powerful impact research can have on your early career and its trajectory.

You are finally finished with medical school, residency, and fellowship. You may ask why would you need to worry about research anymore? You have made it and you are at the peak, up-to-date knowledge of your scope of practice. Yet, the reality is that there is still so much we do not know. New technologies emerge, surgical techniques evolve, and best practices change at lightning speed.

There are many important reasons why research deserves a place in your busy schedule.

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  Better care for your patients: Research helps organize and translate your clinical observations and experience into tangible improvements. Each small change and improvement you make will directly impact your patients.

  
  
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  Cultivate a growth mindset: No one is telling you what to study anymore. Research fosters a critical thinking and problem-solving approach. You will challenge established practices, ask insightful questions, and explore new boundaries. This cultivates a growth mindset which is essential for staying sharp and adaptable in a rapidly changing field as well as providing feeling of professional fulfillment.

  
  
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  Stay ahead of the curve: By actively engaging in research, you become a driver of progress and contribute to the collective knowledge base of the field. This can boost your professional reputation, attract referrals, and open doors to collaboration with other leading surgeons and institutions.

Additionally, there are many reasons to continue research in the first 5 years of practice. In this review article, we explore the means and methods for engaging in research in an early orthopedic career. We weigh the pros and cons of varying research involvements and suggest tips and tricks for cultivating a fulfilling research pathway in the first 5 years of orthopedic practice.

Research as a Trainee Versus a Junior Faculty

Most orthopedic trainees have some research experience as research involvement has become an integral segment of medical training. Medical students applying for orthopedic residency on average list 3.8 published articles, the American Council for Graduate Medical Education requires 60 days of protected research time for residents, and many academic centers consider the number of publications for advancement in professorship. In a recent cross-sectional survey analyzing why medical students participate in research, 43% stated that they did not want to pursue an academic career, though 60% thought pursuing research was still a useful endeavor.

Research as a trainee, however, is very different than research as a junior faculty. Research as a trainee is often a pursuit to get to the next step—medical school, residency, or fellowship. You tap into or piggyback onto your mentor’s projects. They have well-established databases with years of accessible data. They have established relationships with laboratories or colleagues around the country. They have a regional or national reputation that gives your findings and ideas more gravitas. Most importantly, they have established funding to support research endeavors.

Research as a junior faculty entails—no funding, no prior relationships, no prior databases, and really no independent novel ideas—yet. It can be challenging but the motivation is to improve your practice and the care of your patients.

Research is the part that keeps practice exciting and prevents you from falling into the trap that you know everything already. Research is that close monitoring and long-term follow-up. Research keeps you humble and striving for improvement both in yourself and for the benefits of your patients.

Clinical Research

In the first 5 years of practice, clinical research is essentially close monitoring of your patients and their outcomes. It involves close monitoring with patient-reported outcomes (PROs), close follow-up, and making small incremental changes based on your findings.

You are honing your clinical skills and how you like to do things. Every patient is a study patient for you. In the first 5 years, most of this is done by building a research database of your surgical cases. Meticulous record keeping of operative findings and techniques in your operative notes is vital. Follow your patients out further than usual with PROs to understand what makes them successes or failures. In this manner, you will set up research in a method that will allow retrospective analysis of prospectively collected data. The findings from these early studies will fuel further prospective studies such as clinical trials or multicenter studies as you begin to apply for grants or larger projects.

Although clinical research often refers to research regarding patient outcomes from various surgical procedures, it can also encompass cost-effectiveness research, quality improvement or efficiency, or understanding effects of various rehabilitation protocols.

Clinical research can also include systematic reviews and narrative reviews. These do not require patient data or databases and, as such, are attainable for early faculty.

The majority of practicing orthopedic sport surgeons will engage in various forms of clinical research.

Laboratory (Basic Science) Research

Basic science, traditionally, thought of as bench-top research that may involve pipettes or western blots. In sports medicine, basic science may encompass motion analysis, biomechanics laboratories, advanced imaging (MRI), tissue engineering, biologics, and implant design.

In all cases, basic science research asks more fundamental questions, which lays the groundwork for future advancements in clinical research. Basic science in sports medicine affords the benefit of not requiring long-term clinical follow-up, patient databases, or clinical institutional review boards. Basic science research, however, requires more funding and significant collaboration for early faculty. This can be challenging for early faculty. Although some orthopedic surgeons are able to successfully run an independent basic science laboratory while practicing clinical medicine, many of the most successful will have a strong collaboration with a PhD that is dedicated to the laboratory.

If you are interested in basic science research, it will be important during your job search to seek out these opportunities and connect with various laboratories at the institutions you apply to. Seed funding should be secured in your contract as well as dedicated protected time.

Study What Comes in the Door

Regardless of how much you research a position, location, and referral pattern prior to accepting your job, your practice is likely to end up being a little different than you anticipated. There are many factors that you cannot predict—such as how exactly you fit into your practice to not take away from your partners’ clinical volume and how many surgeons in the area have the same interests as you. As you are starting out, you are just trying to get patients in the door and cannot be as selective. You may really want to do research on articular cartilage injuries, but if you only see 1 or 2 a year, it will be hard to generate enough data to conduct good research. It may also become harder to feel that your research is relevant to your clinical practice.

Therefore, one strategy is to keep records of what cases you are seeing over the first 6 to 12 months and how your practice develops. You can take a broad approach with PROs to capture as wide a net as possible. Every 6 months, take stock of what you are seeing, where they are coming from, and then leverage those cases and referrals to build upon a research interests.

Be patient ! Very few sports surgeons walk into their first job with a clinic packed exclusively of high-level athletes. Building a robust elective practice takes time. Remember, patients with challenging pathologies and/or poor socioeconomic determinants need orthopedic surgeons too.

Identify Unique Opportunities and Research Collaborations in Your Institution or Facility

If you prefer a more proactive approach, seek out local opportunities. If you are at an academic institution, look at what other laboratories outside of orthopedics are doing that might present a unique approach. Do you have a business school nearby and want to look at cost-effectiveness or practice management research? Do you have a strong computer science department and want to work on artificial intelligence in orthopedics? Leveraging the expertise of researchers outside of orthopedics and finding ways to expand and enrich their research into a clinical realm can be a win-win for you and that laboratory.

You can also look at your local community to see if there is something that makes it unique. Does your group have a close relationship with local physical therapists—consider research on rehab protocols? Is there a large dance studio nearby—research dance injuries? Do you have a large manufacturing industry nearby—consider evaluating industry-related injuries and outcomes? By engaging with these groups for research, it will also increase your network and referrals.

When meeting other potential researchers or community partners, you should meet them at their time, not surgeon time. The best time for you may be in the morning before your operating room (OR) day, but this is not a normal time for most people. As an early faculty member, you will have the most flexibility in time. More importantly, this demonstrates a level of respect for their time and fosters collaboration.