RESEARCH FORUM--Residency Research, Part II: Goals of Residency
Research
Donald G. Shurr, CPO, PT
ABSTRACT
Residency research should be undertaken both to accomplish the actual research and to develop an appreciation for
the entire process, whether or not the whole process is attempted or completed. The period following school and prior to credentialing provides the practitioner time and purpose for learning and conducting research. The resident benefits from learning research methods, and the O&P field
benefits because the research results may help answer some
of the compelling questions inherent in an ever-expanding
body of knowledge.
Mentors can be catalysts in creating and maintaining successful residency programs and research projects. Currently,
very few mentors exist. Future development of residency
programs will necessitate an increased number of qualified
mentors available for the residents of the future.
Introduction
One of the recommendations included in the "Essentials
and Guidelines for Residency Programs in Orthotics and
Prosthetics" is a research project. Such a project, which is
an important part of a residency program, incorporates the
learning and appreciation for, as well as the process of, research. The addition of research to the criteria for completion of the program exposes residents to the various elements of research.
One might ask, "Why should a resident be involved in research?" and "What are the goals of residency research?"
The criteria for completion of a residency program are very
lengthy and may require many more than 40 hours per
week to complete. On the other hand, this is a very special
time in the professional preparation of future practitioners,
and work weeks exceeding 40 hours are common in many
other professional preparations.
So why should the resident do research? Any practitioner working near the cutting edge of the O&P profession
can list several basic projects that need investigating. Many
complicated problems remain to be solved or at least understood. The day-to-day practice of orthotics and/or prosthetics includes problem-solving on an individual basis. A
more formal look at a problem may hasten an answer and
assist patients and practitioners in the future.
In the past, the Journal of Prosthetics and Orthotics has
published annual lists of authors who have contributed during the calendar year (such as can be found in this issue's
author and subject indexes). It is interesting to note that
from year to year, many of the same people appear on the
list. This means a very small group is doing most of the
scholarly writing for our profession. Several years ago,
then-Editor Charles Pritham, JPO, was rewriting much of
the work since the quality of many of the submitted manuscripts was only average. Due to the small number of teaching programs and even smaller number of graduate programs in the O&P field, most of the articles (and therefore
studies) undertaken today are completed by nonacademicians.
One then can reasonably argue that the resident is the
hope for the future of the O&P profession and therefore
must be skilled in the art and science of research. If the resident does not complete a formal study during residency,
then at least he/she should be familiar with and have an appreciation for the work. As in liberal arts, an appreciation
for the arts and sciences makes the reader more critical and
also reinforces the need to keep up with changes. Such
should be the intent of orthotists and prosthetists.
Goals to Be Attained
One goal of residency research is to introduce the resident
to various kinds of analyses such as case reviews and single subject studies. Descriptive research can be performed by a
resident to collect data as well as serve as an interesting
means of reporting findings or results. The case review provides the author with an avenue that is informative, instructive and capable of producing a worthwhile finished
product.
Another form of research is the survey. Surveys provide
tools with which to gather interesting information and can
supply the resident with answers to many questions.
Aside from the didactic, another goal of such research is to
help provide the O&P profession with much-needed information on numerous topics. Such topics could include the
validation of the O&P fee schedule by providing result and
outcome data about certain devices or applications that have
yet to be reported in literature. This information could produce outcome data commonly requested by third parties.
Another goal of resident research is to use and test new
technologies such as video capture. One way to use video
capture is as a tool to combine the basics and fundamentals
of walking with a computer-aided custom ankle-foot orthosis (AFO) to measure the changes in gait due to treatment.
The same technology could look at the thoracic lumbosacral orthosis and record changes made by the restriction of motion following spinal fracture. Published results
from projects like these could elevate the profession in the
eyes of other allied health providers as well as provide
third-party payers with validation for O&P services.
An alternate goal of residency research could be to produce a new device or modify an existing device.
Implementation
If research is required for all residents, it may be accomplished in different manners. It may include a group effort,
which allows succeeding residents to participate year to
year with each successive resident performing a new phase
of the project. For example, if one resident creates a new
device, successive residents could refine or evaluate the application to future patients. This model has been used successfully in medical schools to collectively develop and clinically test new methods of patient care. It is time orthotists
and prosthetists adopt this model.
As long as a research project is well-conceived and organized, a consistent mentor can maintain the project and adhere to strict time frames to complete the project in as short
a time as possible. Once a problem has been identified and
a methodology has been developed, the mentor can offer
the subjects to be studied and guide residents through data
collection.
To facilitate group research, MDs and PhDs should be
aligned with prosthetists and orthotists to teach the art of
networking for the sake of research. Group efforts can
yield a broad-based and well-conceived methodology as
well as combined resources in today's era of tight budgets
and expanding technology.
If research is to be a requirement in our residency programs, what resources are needed? The most important
part of the residency is the involvement and effort of the
mentor. Each resident must have an advocate/teacher who
can guide the resident through the many facets of research.
Without the mentor, the research will not accomplish
everything it could.
Conclusion
New practitioners are being asked to be part clinician, part
academician and part technician. These are demanding
roles, but the patients and the future of the profession demand people who can perform all three. Mentors must set
examples for residents and assist them in developing clinical problems that are meaningful but confined enough to
allow adequate time for study. Projects also should be
planned so they may be completed in time for the residents' graduation.
Many a new student asks, "How do I identify a problem?
Hasn't everything been studied?" How many times during
a busy clinic day does the practitioner ask, "Where can I
find a concise and complete article dealing with post-polio
syndrome, or Charcot joints, or Charcot-Marie-Tooth disease or the congenital transradial amputee?"
Most articles referenced in leading textbooks do not include information of import to orthotists or prosthetists.
The completion of any research on such topics would be of
great help to practitioners and would afford the resident
the opportunity to accomplish scholarly studies during
his/her professional career.
The inclusion of the research project requirement in residency programs should survive the negatives concerning
time, assistance, qualified mentors and costs. The questioning resident should add to the body of O&P knowledge
thereby improving the profession as a whole. The leaders in
O&P will be the mentors for the residency process. The successful residents will become the future practitioners, problem-solvers and, hopefully, the mentors for the next generation of residents.
DONALD C. SHURR, CPO, PT is eastern district manager of
American Prosthetics inc., 2203 Muscatine Ave., Iowa City, IA
52240.
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