GUIDE TO RESIDENT RESEARCH DEPARTMENT OF SURGERY 2003 Department of Surgery Resident's Guide to Research 2002-2003 page 1 RESIDENT RESEARCH GUIDE TABLE OF CONTENTS: Personnel ...................................................................................................................................... 2 Department of Surgery Philosophy on Research for Residents .............................................. 3 Rationale for Research Training................................................................................................ 3 Terminal Objectives for Research in Surgical Residency........................................................ 4 Overview of the Guide to Resident Research · Computer Resources Available to Residents ...................................................................... 5 · Getting Started & Important Dates ..................................................................................... 6 · Writing a Research Grant Proposal .................................................................................... 8 · How Research Proposals are Judged................................................................................... 9 · Reviewer’s Checklist for Resident Research Proposals ................................................... 10 · Carrying Out Your Project................................................................................................. 11 · Critical Appraisal and Bioethics ........................................................................................ 12 · Research ITERs .................................................................................................................. 14 · Sample research ITER ............................................................................................ 19 · Travel Funds ........................................................................................................................ 15 · Structured Abstract Format............................................................................................... 16 · Sample abstract format........................................................................................... 18 Surgeons’ Day will be held on Friday June 20, 2003 University of Calgary, Health Sciences Centre. Department of Surgery Resident's Guide to Research 2002-2003 page 2 RESIDENT RESEARCH GUIDE Administrative Structure In addition to your research preceptors, there are other individuals and resources in the Department of Surgery who may be able to facilitate your work. Director, Office of Surgical Research (OSR) Dr. Joe Dort (220-4307 HSC) Associate Director, OSR Dr. Paule Poulin, PhD (944-1652, FMC) Office of Surgical Research, Secretary (944-1077 FMC) Education Coordinator, Office of Surgical Education Anita Jenkins (944-1449, FMC) Surgeon’s Day Coordinator Research Committee Secretary } Laurel McDonald (220-5983, HMRB) Division of General Surgery Secretary Judy Mackay (944-8022, FMC) Division of Orthopaedic Surgery Secretary Caroline Eagles (220-3366, HSC) Division of Plastic Surgery Secretary Michelle Mills (944-1905, FMC) Manager, Regional Clinical Departments (Anesthesia and Surgery) Marie McEachern (944-1073, FMC) Regional Clinical Departments, Secretary Holly Underhill (944-2231) Director, Office of Surgical Education Dr. N. Schachar (944-1434, FMC) Office of Surgical Education Secretary Linda Davis (944-1434, FMC) (Surgical Residency Training Committee/ Critical Thinking Course Secretary) AIX Accounts Darlene McKinstry (220-2993) HSC – Health Sciences Centre FMC - Foothills Medical Centre HMRB – Heritage Medical Research Building Department of Surgery Resident's Guide to Research 2002-2003 page 3 RESIDENT RESEARCH GUIDE DEPARTMENT OF SURGERY PHILOSOPHY ON RESEARCH FOR RESIDENTS The philosophy of the Department of Surgery is that each resident will develop the skills to be a critical thinker and a life- long learner. The research process is designed to help you acquire the attitudes, knowledge, and skills to achieve these goals. The Resident's Guide to Research will help you to get started in research by providing you with the process expected by the Surgical Residency Training Committee, as well as the Research and Education Committees of the Department of Surgery. RATIONALE FOR RESEARCH TRAINING The Royal College of Physicians and Surgeons General Standards of Accreditation state that the academic and scholarly aspects of our program must be commensurate with the concept of a University of Postgraduate Education. Residents must be given the opportunity to develop effective teaching and communication skills by means of teaching colleagues and students, conference presentations, clinical and scientific reports, and patient education. The Royal College also specifies that a satisfactory level of research must be maintained among the Faculty identified with the program as evidenced by activity such as: · Publications by staff in peer-reviewed journals, · Involvement by staff and residents in current research projects, · A research budget or research expenditures, · Scholarly activities such as journal clubs, post-doctoral teaching, research conferences, and teaching of critical analysis, and · The presence of a staff member whose responsibility it is to ensure the involvement of residents in research. Residents are encouraged to participate in clinical research during the course of the residency program. Clinical research is defined as research involving human subjects or experimental studies of direct clinical relevance. Acceptable clinical research projects may include: ¨ Analysis of a contemporary clinical problem, using acceptable statistical methods as required, the results of which are reported at local or national meetings and are eligible for publication in scientific journals. OR ¨ Supervised participation in an ongoing experimental research project. Department of Surgery Resident's Guide to Research 2002-2003 page 4 RESIDENT RESEARCH GUIDE TERMINAL OBJECTIVES FOR RESEARCH IN SURGICAL RESIDENCY By the end of the residency program, you will be able to: 1. Conduct a thorough literature review using a computerized database. 2. Evaluate an article from a scientific journal using as criteria: a) Relevance of the topic to current practice. b) Significance of the topic in terms of current surgical research. c) Adequacy of the method of investigation · achievability of study objectives · clarity of focus of the study · clarity of statement of the problem · selection of variables most amenable to study · adequacy of method of selecting sample subjects · appropriateness of hypothesis · validity of data · reliability of data · precision of measurement · appropriateness of methods of data analysis and study design · validity of findings · identify potential sources of bias · adequacy of discussion · validity and generalizability of conclusions 3. Design and execute in conjunction with a research supervisor a research project that meets the criteria noted in #2, by: a) Conducting and analyzing a pilot project with appropriate sample size calculations for statistical analyses, b) Proposing and defending an alternative study design for achieving the study objectives, c) Conducting the full project, and d) Writing and submitting a written report on the project ( peer-reviewed publishable-quality reports are desirable). e) Understanding the process of surgical research including the difficulties and rewards. 4. List the basic principles of grants writing. 5. Review current standards in practice by reading the most appropriate professional journals. 6. Alter your professional practice in keeping with the recommendations from current literature in the field. Department of Surgery Resident's Guide to Research 2002-2003 page 5 RESIDENT RESEARCH GUIDE COMPUTER RESOURCES AVAILABLE TO RESIDENTS Two locations for resource material are: Resident's Lounge Department of Surgery, Room 1102 North Tower Bldg.(access by key, 24hrs/day, 7 days/wk) U of C Medical Library Health Sciences Centre (same level as Foothills main floor). Instruction Available: Orientations to the Medical Library and instruction on computer-assisted literature searches are held daily, Monday through Friday. These classes are taught at a variety of levels and take 40-90 minutes, depending on the level of instruction you desire. For an orientation session and/or assistance, please register at the library reference desk. The CHA has arranged that hospital staff has access to reduced-cost courses offered through the U of C. Contact the Department of Surgery (944-2231) for information. The following aids are available to you: · Access to HKN, Internet and World Wide Web As graduate students of the University of Calgary, you are entitled to accounts on the University's mainframe (AIX accounts). With these (and a modem) you can access HKN, much of the Internet and the World Wide Web from your personal computer─FREE. Application forms for AIX accounts are available from Darlene in HSC Room 1651 (Phone: 220-2993). · Residents' Lounge Computers ( there are three Compaq Power Desktop computers) Please: 1. Do not load any software onto these machines. 2. With the exception of epi-Info (which is shareware), do not copy any software off these machines. The U of C is very strict about complying with copyrights. 3. Only save files in the Folder "Save Resident Files Here" · Associated Hardware 1. Hewlett Packard Scanjet 6300C 2. Hewlett Packarge Laserjet 4 Printer Department of Surgery Resident's Guide to Research 2002-2003 page 6 RESIDENT RESEARCH GUIDE 1. Getting Starting & Important Dates To get started, talk to other residents at your level and to the senior residents, Instructors in the Critical Thinking course, your Division Head, the Chair of your Divisional Research Committee or of the Department Research Committee, and individual faculty members/preceptors in your Division. Your Divisional Research Committee will plan to meet regularly with you to make sure that a research project has been chosen and progress and deadlines are being met. Some infrastructure is in place to assist you to get started, including the Office of Surgical Research (for an appointment, call 944-1652 a Department Research Director, as well as an Associate Director, facilities to do literature searches, computer software and hardware, and a research / critical thinking course (CTC). New residents (PGY1) should identify a preceptor by DECEMBER 31, 2002. If you do not find a preceptor, your Division will assign one to you. Continuing residents (PGY2- 4) should identify a preceptor for their project by DECEMBER 31, 2002. ¨ Research is required by all programs. Please consult with your Program Directors and your Divisional Research Committee Chair to clarify expectations. The minimum expectation for residents for research, along with attendance at the CTC is as follows: PGY1 – Complete a “structured literature review” (in conjunction with CTC). The structured review will be presented as either a poster or a 5-minute oral presentation at Surgeon’s day. The format will be determined by the Divisional Research Committee, in consultation with the resident. PGY2 – Prepare (for CTC) and present a poster, a 5-minute oral presentation (proposal) or a 10-minute research paper at Surgeon’s Day. PGY3 – 4 –A 10-minute oral presentation at Surgeon’s Day outlining the current status of your research study PGY5 – Submit a research paper to a peer-reviewed journal by Surgeon’s Day. ¨ For 2001-2002, all residents’ research proposals will be reviewed by the Divisional Research Committees. ¨ Regardless of whether your research is presented as an oral or poster presentation, all manuscripts and structured abstracts for Surgeons’ Day 2003 must be submitted by April 30, 2003. These materials should be delivered to your Divisional Research Committee Chair. The Abstract must not be longer than 250 words and must conform to the Structured Abstract Format approved by the Department (see pages 16-18 of this guide). The manuscript including abstract and references, but excluding tables and figures, must be a maximum of 10 double-spaced pages and must follow a standard journal format. A maximum of 5 figures is allowed. 2. Surgeons’ Day Abstracts and Manuscripts The Surgeons’ Day Program and Abstract Book is distributed to all who attend Surgeons’ Day. In addition, copies may also be mailed to members of the Department who are unable to attend as well as to the Heads of Departments of Surgery in Canada. ¨ Surgeons’ Day 2003 will be held on June 20, 2003 in the Libin Lecture Theatre, at the University of Calgary, Health Sciences Centre. Department of Surgery Resident's Guide to Research 2002-2003 page 7 RESIDENT RESEARCH GUIDE ¨ PGY1 and selected PGY2 residents (Division dependent) may be giving 5 minute oral presentations that will not be judged by an adjudicator. However, these brief presentations will receive critical feedback from the judges as well as the audience participants. ¨ PGY3 and PGY4 residents are limited to 10 minute presentations with 5 minutes for questions/feedback from the audience/judges. The time limits are strictly enforced, and there will be a 1-point deduction for each 5 seconds over the 10-minute maximum. You are judged according to the quality of your: Abstract (20%) Manuscript (30%) Oral presentation (30%) Audio/visual aids (20%) ¨ The Department of Surgery will support up to $60 per resident for slide production charges. Please call Judy Mackay at 944-8022. Photographic service is available at the Health Sciences Centre (220-6829). ¨ Your abstract must follow the “structured abstract” format (see pages 16-18 and look at a copy of last year's Surgeons' Day Program and Abstract Book). The “manuscript” is limited to 10 pages, double-spaced including text, references (these may be single-spaced), and abstract. References should be numbered in the text within brackets, e.g., , and numbered at the end of the text in alphabetical order. You can use a MAXIMUM of 5 figures/tables as appended pages (maximum one figure or table per page, making a total allowable length of 15 pages. Place legends on the pages with the figures (tables); you do not need a separate page of legends. Adjudicators will not judge quality of figures in an artistic sense; don't worry about professional drawings. Line drawings are suitable, but tables must be typed. ¨ Submit 3 copies of your final, typed manuscript (abstract included in manuscript) to your Divisional Research Group Chair by April 30, 2003. Please submit your abstract on the abstract form (or disk) as outlined on page 16-17. Two copies will be delivered to the judges by the end of the following week to give them time to read and evaluate your written work prior to Surgeons’ Day. ¨ Remember that the manuscript limits are maxima, and they have been established to make all submissions as similar as possible in terms of length and format. You can use less but remember that this is your best opportunity to make your project understood. ¨ Be sure to involve your preceptors in this process; they are there to help you. ¨ Poster presentations will be highlighted during a special session the evening prior to Surgeons' Day. ¨ Surgeons’ Day research symposium is followed by a formal dinner, at which awards for the best clinical science and basic science research papers. ¨ Awards for Research Merit will also be given at the end of the academic year (JUNE 2003) by the Department of Surgery Research Committee, upon the recommendations of the Program Directors, Divisional Heads and the Chairs of the Division Research Committees. These awards are to acknowledge hard work and commitment to research. Department of Surgery Resident's Guide to Research 2002-2003 page 8 RESIDENT RESEARCH GUIDE 2. Writing a Research Grant Proposal (...why learn how to write a grant?) Rationale ¨ To obtain money to do work ¨ To get ethical approval to do work ¨ To convince peers your idea is “worth doing” ¨ To ORGANIZE your thoughts - to formulate a clear plan Background Principles ¨ Reviewers are peers and are often not “experts” in your subject; your project will be reviewed by 2-5 such people. ¨ Reviewers often have multiple grants to review at the same time. ¨ The majority of grants are not well organized, easy to read, or easy to understand. ¨ There is no “standard format” for grants, but most agencies have similar page restrictions (usually 10 pages) and guidelines. ¨ The budget does not influence scientific merit, but the whole project must be “reasonable” (time and money). ¨ For external funding, your “background in research” (i.e. your CV) is critical. To Impress Reviewers ¨ Educate briefly and succinctly in your subject. Convince the reviewers that you are on top of your subject area. ¨ Reference the experts! You must prove that your “idea” is new. ¨ You must be organized. ¨ Make your presentation clear and easy to read. Make your idea logical/simple/important. Have a clear statement of your idea/hypothesis/plan. ¨ Your methods must address your idea! They should be referenced/proven/quantitative. Your method(s) of statistical analysis should be documented. ¨ Your reasons (rationale) for methods must be stated! These must be logical. ¨ You must show that you recognize the limitations of your protocol. ¨ You must acknowledge/address ethical concerns (e.g., consent forms). ¨ Your summary is critical. It will often be what the reviewer uses to complete his/her report. Content vs. Artistic Impression ¨ Content is obviously critical, but artistic impression is impressive. ¨ Attention to detail is critical. Follow the rules! Do not exceed limits. Fill out the forms! FUNDING SOURCES FOR YOUR RESEARCH The Department of Surgery will support up to $60 per resident for slide production charges. Please call Judy Mackay at (944-8022). Photographic service is available at the Health Sciences Centre (220-6829). Contact the Office of Surgical Research about sources and deadlines for extra-departmental grants. Many sources (hospitals, industries, drug companies, foundations, and national and provincial agencies) provide funds-especially for projects that are entering the second or third year, when pilot data are available. Department of Surgery Resident's Guide to Research 2002-2003 page 9 RESIDENT RESEARCH GUIDE 3. How Research Proposals are Judged A sample Reviewer's Checklist (as found on page 10) provides basic information about the 11 areas which are generally assessed in a proposal. The Divisional Research Committee may use these forms in evaluating your proposal. In the Critical Thinking Course (CTC), you are required to develop a research proposal and to present that proposal by Surgeons' Day of PGY2. Ideally, the research proposal you prepared for the CTC and the research proposal you will actually implement will be the same project. To facilitate the development of a quality research proposal, the teaching team of the CTC, the Chairs of the Divisional Research Committees, and the Program Directors will coordinate the evaluations of and the feed back from the research proposals. Although changes may be implemented in the coming year because of Regional Committees (Calgary Health Region), the following committees are in effect. If patients from a specific hospital are used as subjects, then approval must be obtained by the individual Hospital R&D Committee (each institution will have a specific set of forms that needs to be completed). The hospital committee will review the proposals for issues related to patient care and administrative costs. When they have approved the proposal, they will send the research proposal and supporting documents to the University of Calgary Conjoint Medical Ethics Committee. This process may take months before a project is approved. See the following for additional information about the hospital R&D and Ethics Committees. Below is general information about the various review committees at the University-related hospitals and the Conjoint Medical Ethics Committee. The “scientific” reviews of surgical resident research proposals are handled by the Department of Surgery Research Committee. Nonetheless, there are two additional levels of review that any proposal (using human subjects) must pass, before you will be allowed to begin enrolling patients into your study: (1) ethics review and (2) administrative and patient care review. In each case, note the contact person (and phone number) for the hospital. That person, along with your preceptor, will be pivotal in the smooth passage of your proposal through “the system”. University of Calgary Conjoint Health Research Ethics Board (CHREB). Dr. Doig, Chair, 220-7990. ALL University- related hospitals must submit 2 copies of their research proposal and 2 copies of the patient consent form to this committee for final approval. If research is being conducted in an institution that is not affiliated with the other city hospitals, or if research is being conducted at the University of Calgary (and no other hospital committee will be looking at the proposal), the proposal and the consent form must be sent directly to the CHREB. You must adhere to specific paragraphs/sentences of the “patient consent letter”. An example of this consent form can be obtained from the CHREB office (HMRB 93); please note that the first and last paragraphs of the “consent” must be quoted verbatim on your form, and a copy must be given to each participant for his/her file. Foothills Medical Centre - Centre for Advancement of Health (CAH) / Rockyview Hospital (RVH) / Peter Lougheed Centre (PLC). Contact Marlene Payne, Secretary (944-1093). The Adult Research Committee (ARC) requires 13 copies each of the following: application form, proposal (attach copies of the Department of Surgery Research Committee critique/correspondence on scientific review), and the consent form. The application form and sample consent form can be obtained from the CAH, or office of Medical Bioethics which also provides a “Supplement” that is helpful for first time researchers. Revised application forms are available on disk (Microsoft Word & WordPerfect) and also on the website at: www.ucalgary.ca/Md/CAH/research/ Alberta Children's Hospital (ACH). Child Health Scientific Review Committee is chaired by Dr. Dele Davies. The contact @ ACH is Marilyn Ellergodt (943-7241). This committee requires 3 copies each of the following: proposal (attach copies of the Department of Surgery Research Committee critique/correspondence on scientific review), consent form, and CRHA application for Scientific and Administrative Review for Research Proposals (obtain this from the ACH Research Office or the Centre for Advancement of Health at the FMC). Note that certain paragraphs must be quoted verbatim on the proposed consent form. Sample consent forms can be picked up from ACH Research Office. ALL correspondence MUST be forwarded to Marilyn Ellergodt. Department of Surgery Resident's Guide to Research 2002-2003 page 10 RESIDENT RESEARCH GUIDE REVIEWER'S CHECKLIST FOR RESIDENT RESEARCH PROPOSALS Resident's Name: Level of Training: PGY2 [ ] PGY3 [ ] PGY4 [ ] PGY5 [ ] Project Title: Needs Excellent Adequate Improvement Inadequate 1. Ethical Considerations as Appropriate . . . - consent forms [ ] [ ] [ ] [ ] - animal care forms [ ] [ ] [ ] [ ] 2. Importance [ ] [ ] [ ] [ ] 3. Statement of Objective [ ] [ ] [ ] [ ] 4. Literature Review [ ] [ ] [ ] [ ] 5. Statement of Hypothesis [ ] [ ] [ ] [ ] (if appropriate) 6. Specific Aims [ ] [ ] [ ] [ ] 7. Experimental Design [ ] [ ] [ ] [ ] 8. Description of Methods [ ] [ ] [ ] [ ] (other than statistics) 9. Statistical Considerations [ ] [ ] [ ] [ ] 10. Consideration of Strengths [ ] [ ] [ ] [ ] and Weaknesses 11. Overall Quality [ ] [ ] [ ] [ ] (for level of training) (Reviewer's Name/Signature) Date Department of Surgery Resident's Guide to Research 2002-2003 page 11 RESIDENT RESEARCH GUIDE 4. Carrying out your project Regular discussions with your Research Preceptor are essential for the successful planning, conduct, and completion of your research project. Preceptors will be instructed by the Divisional Research Committee Chairs of what is expected of them (see below-Guidelines for Research Preceptors). Problems that occur should be reviewed by the Divisional Research Committee Chair. GUIDELINES FOR RESEARCH PRECEPTORS 1. As a research project preceptor for a resident, you are accepting the responsibility for the successful completion of a research project. This will involve: a) a complete literature review b) a synthesis of that literature review c) development of a question (hypothesis) based on that review and expression of that question in a proposal d) design of an experiment e) conduct of that experiment f) writing a report on that experiment in the normal scientific method format g) the presentation of the project at Surgeons’ Day or other venues h) submission of the work to other meetings (provincial/national/international) 2. Regular feedback is essential to the progress of projects. Dates and timelines are essential, and it will be the responsibility of the preceptor to arrange meetings to discuss the progress. With the resident, preceptors are expected to attend all consultations with design/statistics consultants related to the resident's research project. 3. ITERs on research should be completed every two months (November 15, January 15, March 15) of each year by the preceptor and signed by the resident to ensure written and verbal feedback. 4. Authorship is an important issue which must be discussed early in a project. Intellectual input and workload are obvious criteria for this arrangement. 5. As with other aspects of training, research should be a positive experience. The preceptor is responsible for both guiding the resident and providing constructive feedback. Department of Surgery Resident's Guide to Research 2002-2003 page 12 RESIDENT RESEARCH GUIDE 5. Critical Appraisal and Bioethics The Department of Surgery has developed course materials in “critical appraisal and analysis” to help you fulfil the mandate of the Royal College. The Critical Thinking Course is offered and required of all new PGY1s. It will be taught within your PGY1-2 years to help you to achieve the objectives for biostatistics and epidemiology, “data handling & presenting results”, and “manuscript preparation & how to publish your research”. The CTC evaluation is only one of the factors that a Program Director and Residency Training Committee consider when evaluating a resident's overall research performance. In the area of critical appraisal of the literature, by the end of the residency program, each resident should be able to: 1. Conduct a thorough literature search using a computerized database. 2. Given an article or group of articles from the literature: a) Evaluate the achievability of the study objectives. b) Evaluate the appropriateness of the study design and data analysis in view of the study objectives. c) Analyze the study for potential sources of bias. d) Given the above, evaluate the validity and generalizability of the study finding. e) Propose and defend an alternate study design and approach to data analysis for achieving the study objectives. Specifically, each should resident should understand: 1. Disease causation and prevention a) define and distinguish between descriptive and analytic epidemiological studies and be able to indicate appropriate applications for each type. b) define and distinguish between observational and experimental studies, and be able to indicate appropriate applications for each type. c) define and list the advantages and disadvantages of the following types of studies: - cross-sectional - case-control (retrospective) - cohort (prospective) - experimental d) given a particular study, be able to describe the study type using the terms in objectives a and b above. e) given a particular exposure-disease relationship, and bearing in mind the natural history of the disease, the roles of other potential causative agents, and the availability of suitable study subjects, be able to choose an appropriate study design and evaluate the strengths and weaknesses of the chosen design and its alternatives. f) define, calculate, and interpret: - absolute risk - relative risk - odds ratio g) apply the criteria for causation to a given exposure-disease relationship to evaluate the likelihood that a statistical relationship is, in fact, causal. h) apply the concept of confounding variables to given disease-exposure relationships to explain alternatives to a causal association. i) given examples of absolute risks, relative risks, odds ratios, be able to interpret them appropriately in the context of an individual patient with a given disease or risk factor. Department of Surgery Resident's Guide to Research 2002-2003 page 13 RESIDENT RESEARCH GUIDE 2. Clinical trials a) describe the ethical issues in the conduct of clinical trials, and in the introduction of untried therapies into common medical practice. b) define and, given examples, identify: - unblinded, single- or double-blind studies - randomized versus non-randomized designs and for each, be able to list the strengths and weaknesses c) evaluate the appropriateness of the control group and used in given examples of clinical trials. d) critically evaluate non-experimental designs as alternatives to clinical trials. e) apply skills in interpretation of the medial literature to clinical and management decisions with individual patients and problems. 3. Diagnostic tests and prognosis a) given the necessary data for a diagnostic test, compute and interpret the measures of sensitivity, specificity, negative predictive value, and positive predictive value. b) apply the above values to determine whether a given diagnostic test would be of benefit in a given practice setting. c) understand, in general terms, the meaning and usefulness of cost-effectiveness analysis. In the area of Biostatistics, a resident should understand: 1. Measurement scales (type and quality) a) given a measurement, identify the type of scales used. b) define reliability and validity. c) assess the quality of two measurements by identifying sources of unreliability and invalidity. 2. Data organization (distributions and presentations) a) use frequency distributions, cumulative frequency distributions and cross classification in describing a set of biological measurements. b) correctly interpret results presented in tables, graphs, and diagrams. 3. Descriptive statistics a) calculate basic descriptive statistics to summarize central tendency (mean, median, mode, proportion) and variability (range, standard deviation, standard error) and identify the features of a distribution that each characterizes. b) identify the relationship between two variables as displayed on a scattergram, distinguishing between linear, non linear and no associations. c) recognize that the relationships between two variables can be described by a correlation coefficient which may be positive, negative, or zero. 4. Probability of events a) determine probabilities using frequency distributions and cross classifications. 5. Confidence testing a) interpret the meanings of confidence intervals recognizing that confidence intervals are affected by the precision of the measures. Department of Surgery Resident's Guide to Research 2002-2003 page 14 RESIDENT RESEARCH GUIDE 6. Inferential statistics a) recognize that data may be matched (paired) or unmatched (unpaired) and that the statistical tests used follow from this. b) interpret statements of statistical significance such as the t-test for quantitative data and the chi square test for qualitative data. c) identify how sampling bias occurs and how it may be minimized. 7. Interpretation of the medical literature a) using the above objectives identify data and research findings which may be unreliable and invalid. b) distinguish between statistical and clinical significance. In the context of Bioethics, residents should be able to prepare or review a surgery research protocol from an ethical perspective. Specifically, he/she should be able to: 1. Recognize that the scientific validity and quality of a research protocol are ethically relevant. 2. Identify the issues of confidentiality raised by recruitment, conduct, analysis, and publication of a study. 3. Distinguish research components from the clinical components of a protocol. 4. Identify differences of risk or benefit arising from research components. 5. Construct a consent form which lists the information for ethically valid consent. 6. Describe the best method of assuring valid consent for specific protocols. 7. Identify specific conflicts of interest for physician-investigators, and design methods of reducing such conflicts. 6. Research ITERs Your progress in research will be monitored throughout the year, and Divisional Research Committee Chairs will report back to the Chair of the Department of Surgery Research Committee, to the Education Committee, and to the Divisional and Department Surgical Residents Training Committees. 7. What is next? Although Surgeons’ Day can be one of the highlights of your year, it should not be the end of the trail. Your research should be disseminated to colleagues so that others can benefit from your findings. The two classical methods of reporting your research are through presentations at scholarly meetings and publication in a peer-reviewed journal. Your presentation for Surgeons’ Day is an excellent basis for a presentation at a scholarly meeting. Typically, research- related meetings issue a “call for papers” ask your preceptor or other faculty members about these notices and the timing of local, provincial, and national meetings. After submitting your abstract for review by the program committee of the meeting, you will hear if your paper is accepted for slide or poster presentation. This past year, a few residents from our Department received provincial and national awards for research. Publication in a peer-reviewed journal is the most prestigious and effective means of disseminating your research. Each year many excellent papers are prepared for Surgeons’ Day, but very few are eventually published. The Department of Surgery will intensity its efforts to provide the encouragement, scientific collaboration, practical “how to”, and clerical infrastructure that residents will need to get their research published. Taking a Surgeons’ Day manuscript to publication in a peer-reviewed journal can be a rewarding but sometimes tortuous task. A workshop has been developed that explains the process by which you write and publish a scientific paper. The OSR has resources available for your information on this topic. Department of Surgery Resident's Guide to Research 2002-2003 page 15 RESIDENT RESEARCH GUIDE At the end of the course -“How to Publish Your Research,” each participant should be able to: ¨ list the activities required in preparing a manuscript for submission for consideration for publication, ¨ identify features that editors look for in manuscripts submitted for publication, and ¨ critique a manuscript according to criteria (e.g., Canadian Medical Association Journal or Canadian Journal of Surgery). Presenting and publishing your work not only brings deserved credit to you and your research, but also reflects favorably on your Department and University. More importantly, your results may have an impact on future research, surgical practice, and patient care. Finally, the research that you complete in the coming year may provide a sound basis for a grant proposal for you to obtain funding to continue or expand your work. Contact your preceptor, members of the Research Committee, or other faculty members to find out more about the granting agencies and foundations that can fund your research. Travel Funds to Present your Research When you go to present your research at a provincial or national meeting, the Department of Surgery can contribute support for your travel expenses. In fact, the highest priority for Department Travel Funds is for residents who are presenting their research at a provincial/national/international meeting. The Head of the Department of Surgery will evaluate and decide on your application for travel funds. Your request for these funds, however, must be made and approved prior to your trip. Retroactive requests will be denied. Department of Surgery Resident's Guide to Research 2002-2003 page 16 RESIDENT RESEARCH GUIDE Structured Abstract Format for Surgeons’ Day The Department of Surgery Research Committee has approved a policy of a “Structured Abstract Format” to be used for all resident research abstracts. This policy will continue for the coming year. Each abstract that is submitted for Surgeons’ Day must include: 1. Title of the project 2. Resident's name 3. Structured Abstract 4. Names of preceptor(s) and co-worker(s) You are encouraged to review a copy of the 2001 Surgeons’ Day Program & Abstract Book for other examples of structured abstracts. Attached is a document that illustrates an abstract format (see the following pages 17-18). Please submit your abstract on the abstract form as outlined (p. 18). Submit 3 copies of your final typed manuscript (abstract included in manuscript) to your Divisional Research group chair by April 30, 2003. Two copies will be delivered to the judges by the end of the following week to give them time to read and evaluate your written work prior to Surgeons’ Day. Department of Surgery Resident's Guide to Research 2002-2003 page 17 RESIDENT RESEARCH GUIDE Surgeons’ Day Abstract Please note: Your abstract must fit inside this box. The box will be masked out. Do not touch the lines or your letters will be missing. Title: Resident’s name: Division of ______ Surgery, PGYear University of Calgary The abstract must be a maximum of 250 words, and conform to the structured abstract format: Objective, Design, Setting, Interventions, Main Outcome Measures, Results and Conclusions. Font size must not be smaller than Arial 10pt. Please note: The deadline for abstract submission is: April 30, 2003. Submit 3 copies of your final typed manuscript (abstract included in manuscript) on the abstract form as outlined to your Divisional Research Group Chair Department of Surgery Resident's Guide to Research 2002-2003 page 18 RESIDENT RESEARCH GUIDE The Association Between 6-Month Post-operative Outcomes and Pre-operative Waiting Times in One Surgeon’s Elective Total Hip Practice. Dr. Jason O’Brien, Dr. Lowell VanZuiden Orthopedic Surgery, R4 Objective: To determine if post-op functional outcomes deteriorate as a result of prolonged waiting times prior to total hip arthroplasty in a surgeon’s elective total-hip practice. Hypothesis: Patients who are forced to wait longer for elective total hip arthroplasty have poorer outcome scores at 6 months post- operatively than those who have their surgery performed earlier. Design: A case-series using patients from a surgeon’s elective total-hip registry. Setting: Rockyview Hospital, Calgary, AB Subjects: 45 patients who were awaiting elective total hip replacement. Interventions: Patients who were seen by a local surgeon for arthritis of the hip had their SF-36 and WOMAC scores determined at their initial visit prior to undergoing elective total hip arthroplasty. They were then placed on the surgeon’s elective waiting list. Immediately prior to their surgery, the patients were reviewed again and their SF-36 and WOMAC scores calculated. Following total hip arthroplasty, the patients were followed up by the surgeon at six months post-op. At this visit their SF-36 and WOMAC scores were again calculated. Outcome Measures: WOMAC - Disease specific measure. Short-form 36 Questionnaire (SF-36) - General health measure. Statistical Analysis: Multiple linear least squares regression analysis of pre-operative functional scores in relation to wait-time, and 6-month post-operative functional scores. Results: Waiting time had no effect on 6 month post-operative outcome scores as measured by the SF-36, and WOMAC at 6 month follow- up post elective total hip arthroplasty. Conclusion: Waiting times did not influence post-operative functional scores in elective total hip arthroplasty. .