Non academic clinical researcher

Academic Orthopaedics

Outside the University



Clinician Scientist Development ProgramQuébec City, CanadaJune 1 – 3, 2008


At Scripps Clinic

Clifford W. Colwell, Jr, MD

Why do we do research?Why do we do research?• Enhance patient care

• Find new & better treatments for our patients

• Question current practice

• Advance knowledge

• Incorporate evidence based management into practice

• Enhance patient care

• Find new & better treatments for our patients

• Question current practice

• Advance knowledge

• Incorporate evidence based management into practice

Why don’t we do research?Why don’t we do research?

• Lack of time

• Lack of money

• Lack of time

• Lack of money

Weighing the BenefitsWeighing the Benefits

• Clinical practice is seductive

· You make people better (the reason you became a physician)

· You get praise from your patients

· You get paid for it

• Research has none of the above

• Clinical practice is seductive

· You make people better (the reason you became a physician)

· You get praise from your patients

· You get paid for it

• Research has none of the above

What are we doing?What are we doing?

• Most research leads nowhere meaningful

· Everyone dumps on you – your staff

· Everyone dumps on you – your colleagues

· Everyone dumps on you – your competition and reviewers

· There is little or no personal money involved…

• Most research leads nowhere meaningful

· Everyone dumps on you – your staff

· Everyone dumps on you – your colleagues

· Everyone dumps on you – your competition and reviewers

· There is little or no personal money involved…

If….If….

• You are willing to devote 20% or more of your time to research.

• You have burning questions that you want to solve

• You have passion and persistence

• You can choose the pathway I chose

• You are willing to devote 20% or more of your time to research.

• You have burning questions that you want to solve

• You have passion and persistence

• You can choose the pathway I chose

Now we know where we stand

it CAN be done!


it CAN be done!

How do I get started?How do I get started?• Platform

· Start forming in your mind presently those unsolved problems in orthopaedics that need solving

• Find question you are really interested in

(What are forces in knee?)

• Listen to your patients

· (What problems or questions do they ask that you can’t answer?)

• Platform

· Start forming in your mind presently those unsolved problems in orthopaedics that need solving

• Find question you are really interested in

(What are forces in knee?)

• Listen to your patients

· (What problems or questions do they ask that you can’t answer?)

Initial NeedsInitial Needs

• Ask for help from others with more experience

· (physicians, HSC, grant coordinators)

• Use your mentors

· You can see a lot further if you stand on the shoulders of giants

• Ask for help from others with more experience

· (physicians, HSC, grant coordinators)

• Use your mentors

· You can see a lot further if you stand on the shoulders of giants

Initial NeedsInitial Needs

• Learn some statistics

· Understand difference between statistical differences & clinical differences

• Do a bibliography search

· In all likelihood, if you have asked the question, someone else has asked the question before – it may already have been answered

• Don’t tackle a problem that does not need solving!

• Learn some statistics

· Understand difference between statistical differences & clinical differences

• Do a bibliography search

· In all likelihood, if you have asked the question, someone else has asked the question before – it may already have been answered

• Don’t tackle a problem that does not need solving!

What is your interest?

What is pertinent and significant in

your area?

Where are the priorities in your

area?

Identify topic of interest

All Uni knees

• Objective (purpose) of study

• Uncertainty you want to resolve

• May begin general question – then be narrowed down

• A good research question should pass the test

• Objective (purpose) of study

• Uncertainty you want to resolve

• May begin general question – then be narrowed down

• A good research question should pass the test

Why?

What if…?

So what?

Formulate the problem & research question

Characteristics of a Good Research Question

Characteristics of a Good Research Question

• Feasible · Do I/we have the ability to do it?

• Interesting

· Is it something that I/we care about?

• Novel · Is there limited availability through literature?

• Ethical · Will it not harm the participants?

• Relevant · “So what?”

• Feasible · Do I/we have the ability to do it?

• Interesting

· Is it something that I/we care about?

• Novel · Is there limited availability through literature?

• Ethical · Will it not harm the participants?

• Relevant · “So what?”

PassionPassion

• Comes from your inner soul

• Research is not easy

• Speed bumps occur in the road everywhere you go

• Keep your eyes on the goal

• Comes from your inner soul

• Research is not easy

• Speed bumps occur in the road everywhere you go

• Keep your eyes on the goal

Stay FocusedStay Focused

When you are up to your neck in alligators,

it is hard to remember that your job was

to drain the swamp!

When you are up to your neck in alligators,

it is hard to remember that your job was

to drain the swamp!

PersistencePersistence• Nothing is stronger to overcome

obstacles than persistence

• If it doesn’t work this week – just haven’t given it enough time

• Keep the pressure on!

• Nothing is stronger to overcome obstacles than persistence

• If it doesn’t work this week – just haven’t given it enough time

• Keep the pressure on!

TrainingTraining

• Training to become a successful Clinician-Scientist requires

· Major commitment from

· The individual

· The training program

• Training to become a successful Clinician-Scientist requires

· Major commitment from

· The individual

· The training program

Shiley Center for Orthopaedic

Research and Education(SCORE)

at Scripps Clinic

Shiley Center for Orthopaedic

Research and Education(SCORE)

at Scripps Clinic

At Scripps Clinic

SCORE at Scripps Clinic SCORE at Scripps Clinic

EducationResearch

Quality Patient Care

Progress

Advancements in ResearchAdvancements in Research

SCORE Links 3 Integrated Scientific ProgramsSCORE Links 3 Integrated Scientific Programs

Clinical

Pre-clinical Biomechanical

History of Orthopaedic Research at Scripps Clinic

History of Orthopaedic Research at Scripps Clinic

1983 “Friends of Orthopaedics” make first gifts

1985 First computer donated Study of self-administered pain medication

1994 Research center moves to 2,000 sq. ft. facility

1998 Advanced knee testing equipment acquired

1999 Pre-clinical cartilage research begins

2000 Center moves to 8,000 sq. ft. facility

1983 “Friends of Orthopaedics” make first gifts

1985 First computer donated Study of self-administered pain medication

1994 Research center moves to 2,000 sq. ft. facility

1998 Advanced knee testing equipment acquired

1999 Pre-clinical cartilage research begins

2000 Center moves to 8,000 sq. ft. facility

SCORE2005 Center expands to 18,000 sq ft facility

Renamed: Shiley Center for OrthopaedicResearch and Education at Scripps Clinic (SCORE)

2007 30 staff: MDs, PhDs, nurses, engineers, biostatistician, writers, student interns, administration

2005 Center expands to 18,000 sq ft facility Renamed: Shiley Center for OrthopaedicResearch and Education at Scripps Clinic (SCORE)

2007 30 staff: MDs, PhDs, nurses, engineers, biostatistician, writers, student interns, administration

Current Center ProjectsCurrent Center Projects

• Clinical 15 studies• Clinical 15 studies

0 20 40 60 80 100

Percent

Current Center ProjectsCurrent Center Projects

• Laboratory 33 Projects• Laboratory 33 Projects

0 10 20 30 40 50

Shoulder

Cartilage

Computermodeling

Implant

Percent

Budget developmentBudget development

• At each step, keep in mind the cost

• One time fees (fixed cost)

· Start up/regulatory/overhead

• Labor fees

· Data collection/entry

• Presentation fees

· Develop poster/publication

• At each step, keep in mind the cost

• One time fees (fixed cost)

· Start up/regulatory/overhead

• Labor fees

· Data collection/entry

• Presentation fees

· Develop poster/publication

39%

23%

38% Philanthropy

Grants

Commercial

Funding by Source

* Total income = $3.0 M

NIH Grants Available

Funding SourcesFunding Sources• May be internal funds available

• May need to write grant

· Target group who would be interested in your research

• Commercial company may help by providing drug or device

• May be internal funds available

• May need to write grant

· Target group who would be interested in your research

• Commercial company may help by providing drug or device

How much of your time are you willing to GIVE?

Evidence Based Practice

Practice questions

Literature search

Conduct Research

• Need to let others know about our study findings

• Provides basis for evidence based practice

Disseminate findings

• Submit an abstract – poster or presentation at a meeting (AAOS, AAHKS, WOA, AOA, etc.)

Write the paper!Write the paper!

• Often seems scary, but not really

• The abstract - mini version of paper

• When you write HSC documents, you start writing paper

• Often seems scary, but not really

• The abstract - mini version of paper

• When you write HSC documents, you start writing paper

Disseminate findings


it CAN be done!


it CAN be done!







At Scripps Clinic

Clifford W. Colwell, Jr, MD

Health & Medicine

Non academic clinical researcher