RESEARCH FORUM--Residency Research,
Part III: How to Do Research
During Residency
Robert S. Lin, CPO
ABSTRACT
Scientific or experimental study is critical in the validation of
orthotic/prosthetic clinical practice. The recent adoption of
new education essentials for the orthotist/prosthetist acknowledges this and incorporates research in the undergraduate and postgraduate curricula.
Residents-in-training have many practical goals and objectives throughout the 12-month experiential period. Residents are at the precipice of clinical competency and strive to
enhance their skills through observation, repetition and the
acquisition of knowledge secondary to the formulation of intuitive questions. Their inquisitive nature makes them ideal
candidates to engage in O&P research.
There are many types of research ranging from a simple
case review to an extensive retrospective study of a treatment
methodology. Regardless of format; both types of research
can be undertaken successfully by a resident orthotist/prosthetist while in this crucial graduate training period.
Introduction
In 1993 the National Commission on Orthotic and Prosthetic Education (NCOPE) adopted the new essentials for
primary education of the orthotic/prosthetic practitioner.
An important part of the newly prescribed curriculum is
the study of research through formal instruction and course
work. Subsequently, the new essentials for an NCOPE-accredited residency program also include the research component by means of a research project or initiative to be
completed by the resident during this training period.
The profession's response to this curriculum change has
been varied. One contingent clearly sees the necessity of
enhanced research in O&P and embraces this change with
great enthusiasm. Others feel intimidated by the prospect
of overseeing or being responsible for research conducted
in their practices. Perhaps a review of potential research
scenarios will help allay some of the apprehension that exists today.
The Research Question
The first step in any research initiative is identification of a
problem. The problem or research question is the most critical step of any research process because of its impact on
the direction of all subsequent planning and analysis. The
research question can start out broad and diffuse as one begins to conceptualize the clinical problem, but it should
progressively become more defined.
The investigator (in this case, the resident) then needs to
map out the course of the research planned, including data
collection techniques and the existing literature to be reviewed.
The research question must concisely specify which factors and behaviors will be examined and what types of data will be collected. These characteristics are defined as
variables that must be viewed objectively so their meanings
within the project are clear. Once the variables are identified, the investigator combines them to formulate a hypothesis, or projection of how these variables will be related. This hypothesis then guides the investigation and any
analysis of data being collected (1).
The resident must avoid the common pitfall of designing
a research project: trying to incorporate too many variables. The research question should focus on filling a "gap"
of knowledge. This gap ultimately will be bridged by the data collected if the methodology is valid and complete.
Clinical research often arises from some aspect of clinical practice that presents a question or dilemma. A resident's knowledge, experience and motivation will no doubt
influence the types of questions asked. A resident's relative
inexperience often results in innumerable questions asked
during the training process.
The O&P field is an ideal environment for conducting all
types of research at all levels of complexity. The historical
absence of documentation, outcomes assessment and data
collection in O&P lends itself to a host of fundamental research questions.
For example, the introduction of a new component or design with the manufacturer's claims of superiority and recommendations for use could lay the groundwork for objective analysis of product/design/performance in light of select variables. Resources such as computerized gait analysis, diagnostic imaging tests and/or simple patient chart reviews can shed light on the research question and validate
a specific hypothesis or premise.
The intricate nature of orthotic/prosthetic methodologies and the subsequent anecdotal conclusions derived
from repetition demand research be incorporated into
O&P practices. One should not be discouraged or intimidated if a research question implies, for example, a 200-case
retrospective or prospective study requiring massive man-hours and research acumen. There are ways to break such
a project down into parts that can be carried out over a long
period of time.
Residency research could begin as simply the identification of a problem or question and a literature search performed by the resident at an appropriate library. Simply by
formulating an abstract and outline, a resident becomes
more involved in O&P research than he/she has ever been
before. A study also can be continued from year to year by
subsequent residents if the project's scope is considerable
(2).
Research in Private Practice Residencies
In the private sector, the resources for performing large
clinical studies may be less readily available. However, even
the smallest practice can provide the environment for a single case review where the resident researches a diagnosis
and alternate treatment modalities and presents a well-organized outline of a patient's outcome with a specific orthotic/prosthetic design.
The identification and analysis of the problem, the evaluation of the history, and the search for alternate O&P solutions are in and of themselves research activities. In turn.
a logical presentation (oral or written) benefits the resident-in-training (3).
Another area that cannot be emphasized enough is the
development of new orthotic or prosthetic designs, components and materials applications. Orthotists and prosthetists often are innovative problem solvers. The design of
a "better mousetrap" has been the fundamental principle
driving the evolution of the O&P industry for the past century.
Residents often are inquisitive and taught to ask "why"
during the course of their studies and subsequent clinical
training. Residents graduating under the new NCOPE essentials will have had formal course work and instruction in
research methodologies, and the quest to experience the
full array of treatment modalities makes them perfect candidates for performing research. Ultimately, research will
help any practice achieve a better understanding of the efficacy of its actions or system of operations.
The typical residency program spans 12 months during
which a myriad of tasks and responsibilities are undertaken. Since the focus of this postgraduate period is to achieve
clinical competence, it is easy to procrastinate and delay beginning and carrying out the research project until the very
end of residency training. This often compromises the scope
and quality of the project and diminishes its value for the
resident and the practice alike.
A recommended schedule proven effective for a residency research project requires the research question, abstract and outline to be completed and submitted by the
end of the first quarter. This allows the resident enough
time to generate interest in a particular area while gaining
exposure to patient care. The second and third quarters
should be set aside for data collection and interpretation (if
applicable) and preparation of the project summary. Toward the conclusion of the residency (about month 11), the
project should be complete for public presentation and defense as this represents the culmination of the resident's efforts and acknowledges his/her achievements.
The outlines in Table 1
and Table 2
demonstrate two scenarios
representing both ends of the spectrum of research that a
resident could engage in during residency training. The outline in Table 1
is by far more involved, more complex and
perhaps better suited for institutionally based O&P practices where academic resources may be more readily accessible (4).
Conclusion
As the O&P profession becomes increasingly comfortable
with the prospect of research in practices, it is clear the
quality and scope of research projects will be dramatically
enhanced. Increased awareness about this subject matter
could mean that all types of research eventually will be
conducted in all types of practices.
The resident orthotist/prosthetist is an adult learner who
is in a period of his/her professional life during which
he/she is continuing academic pursuits and grappling with
the underlying principles of clinical practice. Virtually all of
the resident's activities provide an ideal foundation for diligent scientific or experimental study . . . otherwise defined
as research.
ROBERT S. Lin CPO, is director of pediatric clinical services
and academic programs at the Newington Children 's Hospital,
Hartford, Conn. He also is chairman of NCOPE's Residency Review Committee.
References:
- Portney, Watkins. Foundations of clinical research applications to practice.
- Michael J. Researching published information. JPO 1993;
5:4:115-20.
- Lunsford T. Types of clinical studies. JPO 1993;5:4.105-11.
- Curry D. Elements of research in physical therapy. 3rd ed.
Williams and Wilkins.
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