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.