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CORE Aug 6 2008. How to be a Successful Resident Researcher. Achilleas Thoma , MD, MSc , FRCSC Division of Plastic Surgery Surgical Outcomes Research Centre Department of Clinical Epidemiology and Biostatistics. Learning Objectives. The process of pairing with a supervisor

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How to be a successful resident researcher

CORE Aug 6 2008

How to be a Successful Resident Researcher

AchilleasThoma, MD, MSc, FRCSC

Division of Plastic Surgery

Surgical Outcomes Research Centre

Department of Clinical Epidemiology and Biostatistics

Learning objectives
Learning Objectives

  • The process of pairing with a supervisor

  • How to start your research project

  • Determining a timeline for project completion

  • Tips that help keep things on track

Why do research


Why do Research?

  • Because it is a requirement for your program

  • Resident research day is fast approaching and you are expected to present

  • You want publications to build your CV

Why do research1


Why do Research?

  • You have the passion to improve your knowledge

  • You want to apply for a MSc or PhD program through the Clinical Investigator Program or HRM Program

  • You have the passion for scientific inquiry and to advance your specialty

Types of residents


Types of Residents

  • “Talkers”

  • “Doers”

    Which are YOU?

Resident research productivity


Resident Research Productivity

  • “Talkers” have no publications by the time they have completed their residency program

  • “Doers” will have published at least 1 article / year in their residency program and will have presented their work at their national society meetings

Prerequisites for success


Prerequisites for Success

  • Passion

    The emotion of feeling very strongly about a subject

  • Initiative

    The ability and tendency to initiate: to start an action and maintain momentum on the project

Finding your supervisor

1. Supervisor

Finding Your Supervisor

  • Match your research interests with supervisor expertise

  • Do some “detective work” on the supervisor

  • Read the supervisor’s publications and be familiar with his/her work

  • Ask if she/he available to meet with you after 5 pm / the weekends

Expectations for supervisor

1. Supervisor

Expectations for Supervisor

  • Supervisor is available to meet in the off hours (i.e. after 5pm / weekends)

  • Supervisor has done some research

  • Supervisor is willing to provide timely feedback and guidance on the research project

  • Supervisor is willing to devote the time and energy to assist you

Expectations for resident

1. Supervisor

Expectations for Resident

  • Be a “doer” rather than a “talker”

  • Resident initiates weekly meetings and gives progress reports on his/her research project

  • Keeps minutes of discussions and action plan after every meeting and gives copy to supervisor

  • Knows the basics of research designs

Roles of a supervisor
Roles of a Supervisor





1. Supervisor


Office space and supplies (e.g. photocopying, internet access)

Secretarial and administrative support

Financial support to attend meetings, conferences, courses

Research coordinator support

1. Supervisor


Join ongoing research projects

Help review manuscripts and grant applications

Attend meetings

Learn about Research Ethics Review Committees

1. Supervisor


Methodological challenges of project

Pros and cons of working with particular collaborators

Time management

1. Supervisor


Opportunities to practice presentations and defend your conclusions in a friendly atmosphere, before presenting at a national meeting.

1. Supervisor

Starting your research project

2. Organizing Research

Starting your Research Project

  • Is the question you are trying to answer in your research project clinically important or trivial?

  • Distinction between the trivial and important questions is not that easy…

    the answer lies in scholarship

Reasons to pursue a research question
Reasons to Pursue a Research Question

Intervention is novel

Intervention consumes large health care resources

Controversy on the effectiveness of the novel procedure

Large cost difference between 2 prevailing interventions

2. Organizing Research

Starting your research project1

2. Organizing Research

Starting your Research Project

  • You have to be familiar with the boundary of knowledge on the subject

  • To do this you have to first perform a systematic review of the subject (i.e. thorough review of the literature)

Research is an iterative process

2. Organizing Research

Research is an Iterative Process


Collaborate with other residents / medical students

2. Organizing Research

Initial groundwork for research question formulation
Initial Groundwork for Research Question Formulation





2. Organizing Research


Is the question answerable?

Must have a thorough understanding of the anatomy, biology, physiology and prevalence of the problem

2. Organizing Research

Plausibility example

2. Organizing Research

Plausibility Example

  • It is not plausible to examine the outcomes of reconstruction of the congenitally absent ear in a RCT comparing the Nagata technique with the “genetic engineering method”

  • The genetic engineering methods are not advanced at this point in time to regenerate an acceptable ear


Whether the study design we choose is one that can potentially answer the research question

Best study design depends on the question being asked

2. Organizing Research

Feasibility example
Feasibility Example

Research Question:

Is the supramicrosurgical reconstruction with a periumbilical abdominal flap is superior to the deep inferior epigastric perforator (DIEP) flap in breast reconstruction ?

Possible barriers:

We don’t know how to transfer a flap with a 0.8 mm luminal diameter of the vascular pedicle

We don’t have the required instruments

QOL scales may not be sensitive enough

2. Organizing Research


Choosing a Study Design

Simple Studies (i.e. Case series, Cohort)

If little is known on the topic, or there are big gaps in knowledge


When a novel surgical technique entered the main stream of surgery and challenges a prevailing one

2. Organizing Research

Feasibility example1

2. Organizing Research

Feasibility Example

Research Design:

  • RCT to determine whether smoking affects the short-term survival of replanted digits


  • Ethically, we cannot randomize patients to either Group A: continue smoking or Group B: non-smoking after replantation of digits.

  • For questions of harm, appropriate study designs include case-control studies and cohort studies

Feasibility example2
Feasibility – Example

Research Design:

RCT comparing the use of intermittent lower extremity pump vs. low molecular heparin in preventing fatal pulmonary embolism in cosmetic abdominoplasty.

Possible Barriers:

Fatal pulmonary embolism in cosmetic abdominoplasty is a very rare event.

As the frequency of the ‘end points” is a critical factor in the sample size calculation, the rarity of the target event means that the investigator will require a sample size measured in thousands of patients!

2. Organizing Research


Financial resources

Think of the budget and the details that go with that!

Choose a supervisor who has research coordinator support

2. Organizing Research

Forming the research question

2. Organizing Research

Forming the Research Question

  • You have an idea, the necessary support and resources now you need to transform your research idea into a well built clinical question

Background questions

2. Organizing Research

Background Questions

  • Ask for general knowledge about a surgery problem

  • Have two essential components:

    • A question root (who, what, where, when, how, why) with a verb

    • A disorder, or an aspect of a disorder

      i.e. What complications can occur with the ECTR?

Foreground questions

2. Organizing Research

Foreground Questions

  • Ask for specific knowledge about managing patients with a surgery problem

    5 essential components:

    Patient or problem


    Comparison intervention (if relevant)



Well built clinical question

2. Organizing Research

Well Built Clinical Question

  • Population (patient)

  • Intervention

  • Comparison (this is optional)

  • Outcome

  • Time Horizon

Population patients

2. Organizing Research

Population (Patients)

  • How would I describe a group of patients similar to mine?

    • Be brief and precise

      i.e. All patients with clinical evidence of carpal tunnel syndrome confirmed with EMG and nerve conduction study


2. Organizing Research


  • Which main intervention, prognostic factor or exposure am I considering?

    • Be specific

      i.e. In ECTR, the Agee or the Chow technique or extrabursal or intrabursal

Comparative intervention

2. Organizing Research

Comparative Intervention

  • What is the main alternative to compare with the intervention?

    • Be specific

      i.e. In OCTR, short incisions and long incisions, as these incisions allow one to visualize the median nerve


2. Organizing Research


  • What can I hope to accomplish, measure, improve or affect?

    • Be specific


    • Pain control

    • Return to work, ADL

    • Improve Quality of Life (QOL)

    • Quality Adjusted Life Years (QALYs)


2. Organizing Research


  • How will you measure them?

  • Who will measure them (think of bias introduction)

  • How often will you measure them?

Time horizon

2. Organizing Research

Time Horizon

  • Appropriate time to measure outcome

    • 1 month post-op

    • 6 months post-op

    • 1 year post-op

    • Long term >5 years

    • For the patient’s life?

  • Short, intermediate, long term follow-up

  • Time horizon1

    2. Organizing Research

    Time Horizon


    • Population --- chronic osteomyelitis of tibia patients

    • Intervention ---free muscle flap

    • Comparison --- free cutaneous flap

    • Outcome ---no drainage of pus from tibia

    • Time Horizon --- 2 years

    Framing the clinical problem

    2. Organizing Research

    Framing the Clinical Problem

    Research timeline

    3. Timeline

    Research Timeline

    Formulation of Research Question & Study Protocol Development

    Patient Recruitment; Data Collection

    Data Analysis

    Manuscript Writing

    Present at Peer-Reviewed Meetings

    4 Months

    8 Months

    1 Month

    2 Months

    Time management

    3. Timeline

    Time Management

    • Set a realistic goal for completion!

    • The onus is on YOU!

    Time management1
    Time Management!

    The most important element of time management for academic success is setting aside time for your project

    3. Timeline

    Communication issues

    3. Timeline

    Communication Issues

    • You have to communicate and negotiate with onsite clinical supervisor ahead of time the time required off your clinical duties to perform your research project

    • Need clear contract and understanding organized ahead of time

    Your success

    4. Tips

    Your Success

    • Keep up the momentum!

    • Report progress weekly to your supervisor

    • The onus is on you to keep the project going


    Break into Groups by specialty

    Design a clinically important research project in your specialty (based on PICOT)


    • Who will be your supervisor will be and why?

    • What study design will you use to answer your question?

    • Provide a detailed budget

    • Discuss the feasibility of the project in a 5 year residency program

    • List 5 difficulties you will experience in executing the project