The
Research Enterprise in the
Department of Orthopaedic Surgery
Wake Forest University School of Medicine
The Department of Orthopaedic Surgery has a three-fold mission: 1) clinical care, 2) education, and 3) research. Research, representing one-third of our mission, receives a high priority within the department. Experience and education in research methodology is an important component of the residency and fellowship programs in the department. The residents, research fellows, and hand and trauma fellows actively participate in ongoing research with the opportunity to pursue independent projects. Mentoring and technical support is available to fulfill these goals. The research laboratory is a key component for ensuring that faculty members and residents are able to successfully complete their research goals. Therefore, the research laboratory and its staff serve as a resource for assistance with resident, fellow, and faculty research.
The Orthopaedic Surgery Research Laboratory operates under a 5-year plan. This plan is updated every 2-3 years to accommodate research advances and new research interests developed within the department. The Laboratory has a long history of extramural funding from foundations, industry, and the NIH.
Over the past decade, the Department of Orthopaedic Surgery has grown steadily increasing the number of clinical sub-specialties represented by the faculty, the number of research projects, and the scope of research interests. Current research areas under investigation include traditional biomechanical testing, neuromuscular physiology with directed research in the field of nerve repair, nerve repair in aging, Raynaud's phenomenon (primary and secondary) and diabetic foot problems, molecular biological expertise in the area of receptor physiology (muscle and vascular), cell culture of osteoblasts for studying osteomyelitis, microsurgical technique development, limb-lengthening, and biological mechanisms of action of pulsed electromagnetic fields. The department is actively collaborating with the Wake Forest Institute for Regenerative Medicine and the section of Molecular Medicine to develop new techniques for anterior cruciate ligament, nerve, and meniscal repair.
Outcomes research and clinical trials are a major portion of the clinical research efforts within the department. Clinical research includes comparisons of anterior cruciate ligament repair techniques, minimally invasive arthroscopic surgical techniques, traumatology, pediatric cerebral palsy, neuromuscular blockade for spasticity management, intrathecal baclofen for spasticity management, diabetic peripheral autonomic dysfunction, Human Leukocyte Antibody (HLA) sensitization in bone allografts, and total joint research.
The research laboratory serves as a resource to provide expertise in clinical trial design, data collection techniques, biostatistical analysis, development and utilization of animal models, preparation of manuscripts and grant proposals, and coordination of research activities. Clinical research activities are facilitated by in-house clinical project managers who assist with compliance with IRB and HIPAA regulations. Audio-visual facilities with computer graphic capabilities and medical illustrators are also available for the presentation of research findings at meetings and through publication of books, book chapters, and journal articles.
L. Andrew Koman, MD, Professor and Vice Chair
Beth Paterson Smith, PhD, Associate Professor
Thomas L. Smith, PhD, Associate Professor
Michael Callahan, PhD, Assistant Professor
Cristin Ferguson, MD, Assistant Professor
Jianjun Ma, MD, PhD, Instructor
L. Andrew Koman, MD, is the Director of Research in the Department of Orthopaedic Surgery. Dr. Koman also serves as the Associate Director for Development and Research for the Division of Surgical Sciences. Dr. Koman chairs a weekly departmental research meeting that is designed to monitor the progress of research projects and to develop new research areas. Participants in this meeting include: members of the research faculty, physician scientists, the PGY-3 resident on their research rotation, and all medical students, graduate students, or fellows who are involved in departmental research.
Beth Paterson Smith, Ph.D. supervises, coordinates, and directs the day-to-day operations of the Orthopaedic Research Laboratory by assisting faculty members and residents in developing and planning grant applications, in developing experimental protocols and research models to address research questions, and in organizing data collection and statistical analysis. Personnel (fellows, residents, medical students, and graduate students) involved in various research areas work under the direction of the various orthopaedic faculty members with Dr. Beth Smith serving as a facilitator to expedite the realization of research goals.
Thomas L. Smith, PhD, and Michael Callahan, PhD supervise, coordinate, and direct the day-to-day oversight of the basic science studies performed in the Orthopaedic Research Laboratory. Both have extensive experience in the use of animal models to answer research questions. They also assist with the development of new techniques to implement novel basic science research protocols. Dr. Thomas Smith also serves as the program coordinator for the 7 year physician scientist program. The Physician Scientist trainees are trained under a dual mentorship program. An orthopaedic surgeon and a basic scientist guide each Physician Scientist in their selection of research topics and ensure that they have access to the resources required for the successful completion of their chosen research project.
Cristin Ferguson, MD recently joined our faculty as a clinician/researcher following her completion of a Sports Medicine Fellowship at the Hughston Clinic in Columbus, Georgia. The focus of Dr. Ferguson's research is directed toward understanding the molecular biology of the meniscus and the molecular mechanisms of meniscus repair. The goal of this research is to develop biologically compatible and mechanically functional meniscus replacements that can be used in select patients to help retard the progression of osteoarthritis. Dr. Ferguson has developed several models for her studies including cell and organ culture of the meniscus, in vivo rabbit models of meniscus healing, and mechanical stimulation of meniscus cells in culture using Flexercell Strain unit apparatus and bioreactors. Dr. Ferguson is collaborating with the Section on Molecular Medicine and the Wake Forest Institute for Regenerative Medicine to develop these studies.
Jianjun Ma, MD, PhD, supervises the work of the 7 year physician scientists and serves as a resource in the development of basic science and clinical studies related to nerve injury and repair and the effect on neuromuscular blockade on nerves. His area of expertise is the development of new methods to facilitate nerve repair. Dr. Ma also has received funding to study the changes in nerves and neuromuscular junctions following injections of botulinum toxin, the effects of aging on nerve function and regeneration, and new techniques for nerve repair.
Two full-time laboratory technicians are employed in the Orthopaedic Research Laboratory to work with orthopaedic faculty, residents, and fellows. One of the laboratory technicians, a registered veterinary medical technician, is available to assist with animal surgeries and post-surgical monitoring of experimental animals. One full-time secretary provides clerical support for the laboratory. This secretary assists in the preparation of clinical and basic science research protocols, study data forms, abstracts, grant applications, and manuscripts submitted for publication. Assistance is also available for completing literature searches.
Laboratory personnel responsibilities include performing clinical evaluations in the Extremity Laboratory, managing patient files and billing, implementing research protocols, preparing and updating literature searches, maintaining scientific journal databases and files, ordering and maintaining equipment and supplies, assisting in animal model preparation and animal care, training ancillary personnel, performing data compilation and statistical analysis, and computer operation.
The Department of Orthopaedic Surgery also employs two clinical research coordinators. These individuals are responsible for ensuring that the data forms for the various clinical studies are completed and that patients in research protocols are scheduled for appropriate study visits, including follow-up appointments. They work with the medical school and the hospital to facilitate the collection of necessary clinical data, health-related quality of life data, and medical care expense data. They also are involved in ensuring that all IRB and HIPAA regulations are followed in all clinical research protocols.
The departmental computer specialist assists with research by designing research databases and supervising the entry of study data. Data sheets and other data collection instruments also are designed within the department by our computer specialist. The department also has developed a web-based data collection system so that research data can be collected in the clinic as patients are treated. The computer specialist performs data verification, data entry, and statistical functions.
Collaborations with the Department of Public Health Sciences
To ensure appropriate study design and data analysis, the Department of Orthopaedic Surgery has developed collaborative efforts with the Department of Public Health Sciences. Faculty and staff from this department assist in experimental design, data form development, and statistical analysis of the projects developed in our department. Clinical studies within the department include collaborations with the Department of Public Health Sciences in outcome studies, health-related quality of life studies, and health economics studies.
Orthopaedic Research Laboratory Facilities
Research activities are conducted in contiguous research space (2,195 square feet) including two offices, secretarial space, five support spaces with computer work stations, wet laboratory space (1,659 square feet), and an approved satellite, small animal operating room equipped with operating microscopes, anesthesia equipment, and cautery.
The Orthopaedic Extremity Laboratory provides support for both clinical evaluations of microvascular control of upper and lower extremity blood flow. This laboratory provides critical clinical information regarding digital microcirculatory perfusion in patients with scleroderma, lupus, reflex sympathetic dystrophy (complex regional pain syndrome), nerve injury, vascular injury, and diabetes. These conditions are associated with pathophysiological alterations in microvascular blood flow. Information gathered from the testing techniques available within the Extremity Laboratory is used to study digital perfusion in patients with a variety of different diagnosis as well as providing a method to evaluate their responses to medical and surgical interventions. Evaluations conducted in the Extremity Laboratory include combined isolated cold stress testing and laser Doppler fluxmetry measurements of extremity microvascular blood flow. The Extremity Laboratory also is equipped to perform vital capillaroscopy to evaluate digital cutaneous nailfold microvascular blood flow. The laboratory also houses a laser Doppler perfusion imaging system. This laser Doppler technology produces sequential measurements of cutaneous perfusion at contiguous sites on the skin of the hands and/or feet. Specialized computer software then produces a color-coded scan representing cutaneous perfusion of the scanned area.
Molecular Biology and Tissue Culture Laboratory
The Department of Orthopaedic Surgery has developed collaborative efforts to study the molecular biology of nerves with Kim Tan, PhD, Professor of Biology at Winston-Salem State University and adjunct professor in Orthopaedic Surgery. Dr. Tan's state-of-the-art laboratory is located at the Piedmont Triad Community Research Center. With Dr. Tan's collaboration, researchers within the department can perform real time Reverse Transcriptase-Polymerase Chain Reaction Assays, develop gene array assay systems, and perform tissue culture studies. The resources in this laboratory are available to provide a broad spectrum of molecular biological techniques to study musculoskeletal physiology at the molecular level.
Core Facilities at Wake Forest University School of Medicine to Facilitate Research
Center for Nanotechnology: This new center in the Department of Physics at the Wake Forest University has already become an active partner with the Department of Orthopaedic Surgery. Joint research proposals have been submitted to the National Science Foundation and the National Institutes of Health as collaborative efforts between the two departments. For example, Dr. Webb is collaborating with the Nanotechnology Center on a project utilizing Atomic Force Microscopy to characterize the glycocalyx of antibiotic-resistant S. aureus. The nanotechnology center has near field microscopy capabilities together with scanning, transmission, and tunneling electron microscopy that can be used to address orthopaedic research questions.
Wake Forest Institute for Regenerative Medicine: The Wake Forest Institute for Regenerative Medicine is focused on tissue engineering and the use of autologous patient cells for use in therapy. Tissue engineered human bladders, urethras, and vaginas have been developed to date. Functional blood vessels (carotid arteries) derived from autologous cells also have been tested in vivo in sheep for periods up to one year. Wake Forest Institute for Regenerative Medicine has developed the technology to produce "bioartificial" scaffolds for applications in tissue engineering. Bioartificial scaffolds essentially are decellularized tissues and organs from which the potentially immunogenetic components (i.e., the cells) have been removed. This means that what remains of the tissue or organ is intact extracellular matrix. Initial investigations of fresh-frozen and lyophilized human Achilles tendon allografts have been used to determine if scaffold modeling techniques have the potential to improve the clinical performance of the allograft in anterior cruciate ligament reconstruction surgery. Collaborative studies also are underway to evaluate various materials to serve as conduits to facilitate nerve repair. For example, several orthopaedic faculty members and orthopaedic residents are involved in collaborative studies to develop tissue engineering technologies to address improving methods to manage nerve defects that involve large nerve gaps. Current collaborations with the Institute for Regenerative Medicine are focused on engineered blood vessels and nerves for extremity reconstruction, the development of techniques to improve allograft anterior cruciate ligament repair, and the design of meniscal replacements.
The Institute encompasses 6,000 square feet. Facilities and equipment pertinent to orthopaedic research include an Instron biomechanical tester and imaging facilities. In addition, a histology area is available consisting of a tissue processor, paraffin embedding station, slide warmers and water baths, microtomes, and light microscopes. Cell culture facilities include an incubator, biological hood, and other basic cell culture items.
Comparative Medicine (Non-Human primate) Clinical Research Center (CMCRC): This unit was created in 1989 by Dr. Thomas Clarkson to conduct research in non-human primates to gain insights into human health and disease. The facility is a 200-acre campus ten miles south of the Medical Center main campus that has extensive AAALAC-accredited facilities for the care and housing of approximately 1,000 nonhuman primates. The center also includes a large complex of laboratories and offices. Animal care is directed by a staff veterinarian and four ACLAM-certified veterinarians. The CMCRC is supported by an extensive Data Services Core and the CMCRC computer system interfaces with the Medical Center main campus system for communication and access to additional software and hardware capabilities. The CMCRC also maintains Clinical Chemistry (T. Register, Director) and Diagnostic Pathology (JM Cline, Director) Cores. The CMCRC performs studies of basic pathobiology and applies these outcomes to clinically relevant models. A major ongoing research program is the evaluation of osteoporosis in female non-human primates. The CMCRC faculty have expertise in bone biology and bone densitometry. A valuable resource at the CMCRC is access to Quantitative Computerized Tomography.
General Clinical Research Center (GCRC): The mission of this center is to provide clinical investigators with the fundamental resources and controlled environment necessary to conduct clinical research. The GCRC also helps clinical investigators incorporate basic scientific findings into clinical applications and improved patient care. Resources available within the GCRC include nursing, dietary, and laboratory personnel trained in research techniques; fully equipped inpatient and outpatient rooms; and state-of-the-art laboratory and patient monitoring equipment. The GCRC is supported by a NIH grant and serves as a focal point for clinical research in nutrition, atherosclerosis, hypertension, stroke, renal disease, and cancer. The Center is committed to training young investigators and participates in the Clinical Associate Physician (CAP) program, a competitive NIH program for junior physician scientists. Weekly clinical research seminars for young investigators compliment the educational opportunities afforded by the GCRC.
Molecular Genetics Program (MGP): This resource was created in 1986 by Dr. Mark Lively to facilitate molecular biology research by the faculty of the Wake Forest University School of Medicine. A PhD degree in Molecular Genetics was established in 1991. The mission of the MGP is to provide and maintain instrumentation and laboratory and computer facilities for molecular biology research that are accessible to all investigators at the Medical Center. Two core laboratories within the MGP maintain instrumentation for DNA sequencing and protein analysis. Although the MGP is maintained on a fee for-service-basis, the costs are low because the Wake Forest University School of Medicine contributes basic dollars to defray costs associated with service contracts and technician salaries. The Molecular Genetics Program provides core facilities for the Molecular Medicine Program including DNA sequencing, RNA primer construction, proteomics equipment, and state-of-the-art molecular biology laboratories.
The Section of Molecular Medicine serves to facilitate translational research between clinical and basic science faculty (Hyperlink). A particular research focus of their programs is cell signaling and the regulation of gene expression. Currently, collaborative studies between the Department of Orthopaedic Surgery and the Section of Molecular Medicine include studies to use a mouse model of osteoarthritis to study changes in cartilage and meniscus.
Transgenic Animal Facility: The advent of genetic engineering created the opportunity to study the role of genes in the maintenance of homeostasis and the causation of disease. The mouse is the primary species used for development of transgenic models. The Medical School has made a significant investment in building a transgenic animal facility with pathogen barriers and full veterinary support. This facility allows investigators to house and breed transgenic animals at the Medical School. An expert in the development of transgenic mouse models is available to assist individuals with specific models for their research areas.
J. Paul Sticht Center on Aging and Rehabilitation: The Sticht Center includes a Geriatric Research Center which houses a biomechanics and strength laboratory, including a gait analysis laboratory. The center also houses the Pepper Center funded by a grant from the National Institute on Aging. The mission of the Pepper Center is to assess risk factors of physical disability in older adults, to develop and test effective prevention therapies to manage these disabilities, and to train and educate investigators in geriatric research.
CompRehab Center: The CompRehab center provides a significant clinical resource for the Department of Orthopaedic Surgery. In addition to the orthopaedic clinics held at CompRehab, patients who require outpatient rehabilitation are treated at this facility. Therefore, CompRehab includes clinical, diagnostic, and rehabilitative programs and services at the same location. CompRehab compliments the Sticht Center on Aging and Rehabilitation by providing outpatient care for Orthopaedic Patients as well as rehabilitation for neurology patients. The Hand Center, Musculoskeletal Center, Neurorehabilitation Center, Sports Medicine Center, and Vocational and Occupational Rehabilitation centers are located within CompRehab.
Bone and Joint Center: The Bone and Joint Center of the Wake Forest University Baptist Medical Center represents a collaboration between the Medical Center and the Department of Orthopaedic Surgery. The overall goal of the Bone and Joint Center is to improve the level of care provided to patients with musculoskeletal problems. A model project within the Bone and Joint Center is an outcomes study examining the treatment pathway for osteoarthritis of the knee and hip. This project develops treatment pathways for patients at the Medical Center to assess methods to optimize treatments and outcome.
Musculoskeletal Research Center: The Musculoskeletal Research Center, located within the Department of Orthopaedic Surgery, represents the complimentary basic research program of the Bone and Joint Center. This Research Center supports several research projects across a wide range of musculoskeletal research disciplines. The majority of these studies are collaborative in nature, drawing upon the expertise of collaborators in other Medical Center Departments as well as from other universities.
Virginia Polytechnical Institute: A partnership has been established between Wake Forest University and the Center for Biomedical Engineering at the Virginia Polytechnic Institute and State University (Virginia Tech) and has led to the establishment of the School of Biomedical Engineering and Sciences. This program offers research and educational collaborations between the campuses at Wake Forest and Virginia Tech. This partnership strengthens Wake Forest University School of Medicine's Medical Engineering Group, a Biomedical Engineering School established within Wake Forest University, and allows the Biomedical Engineering Department of Virginia Tech direct access to clinical research opportunities. One of the collaborative projects involving the Department of Orthopaedic Surgery and Virginia Tech is the development of a computer-assisted technique for characterizing hypertonia in patients with cerebral palsy in order to provide a quantitative measure of spasticity that can be used to evaluate the effects of various treatments on muscle spasticity. This grant is supported by an NIH small grants program from the Taskforce on Childhood Motor Disorders.
MicroMed Core Lab: This is a Medical School core facility offering access to state-of-the-art electron microscopy (scanning and transmission), confocal microscopy, and fluorescence microscopy. Advance image capture and image analysis capabilities are also available. Skilled professionals are available for assistance and training on the different types of equipment housed in this facility at no cost. There is a fee for service but the costs are minimal because support for the center is underwritten by the Medical School.
Physician Scientist Program
The field of Orthopaedic Surgery is evolving with the development of new biological solutions designed to interface with traditional surgical constructs in order to address orthopaedic pathologies. The focus of traditional orthopaedic residency training is to provide instruction and experience in the provision of health care delivery. Although traditional 5-year residence programs include training in research, residents do not have sufficient time during their resident experience to pursue a rigorous course of research. A 1992 study of the American Academy of Orthopaedic Surgeon's Council on Research reported that "The number of orthopaedic surgeons trained in techniques of basic musculoskeletal research and committed to career involvement in research is inadequate and probably is continuing to decline". A follow-up study by Clark and Hanel in 2001 determined that only 29 MD-PhD trained physicians were participants in academic orthopaedic departments. The authors suggest that the availability of an alternative intensive research experience is a potential mechanism for training orthopaedic residents to become academic faculty members. The shortage of academic orthopaedic research physicians also was highlighted by Hurwitz and Buckwalter (Editor of the Journal of Orthopaedic Research) in 1999. These authors suggest that junior orthopaedic faculty are not prepared to become scientists, and that even programs that provide one free day per week for research, do not necessarily transform orthopaedic surgeons into successful researchers. These authors further propose that specific training in research methods and grant writing is necessary in order for junior faculty members to become successful researchers.
In order to address
the small number of research trained orthopaedic surgeons, the Department of
Orthopaedic Surgery initiated a Physician Scientist program in 1998. This program
is designed to provide two years of uninterrupted research experience that is
then followed by the completion of a standard five year orthopaedic residency
program. This research program is structured to train physician scientists to
address the orthopaedic problems of the 21st century. The goals of this program
are:
1) To increase the number of academic orthopaedic surgeons with the requisite
training to address basic and clinical research questions related to Orthopaedic
Surgery
2) To promote and foster collaborations between basic science disciplines and
orthopaedic surgeons in order to address complex medical questions
3) To translate research findings from the "bench to the bedside"
This program is supported by the commitment of a multidisciplinary group of scientists and physicians at Wake Forest University School of Medicine. Members of this group have formulated a unique program to educate and mentor future orthopaedic surgeons in academic research. This model trains physician scientists to adapt new knowledge in the area of orthopaedic surgery in order to develop strategies for new treatments and preventive programs. Much of the "cutting edge" research in orthopaedic surgery is focused in the area of molecular medicine and the implementation of biologic interventions for addressing traditional orthopaedic problems of fracture management and cartilage injury and disease. In addition, outcomes-based orthopaedics is a major research initiative that is based on the study of objective, quantitative assessments of outcomes following specific orthopaedic interventions. Experience in both types of research is available to fellows who complete the Wake Forest physician scientist program. The ultimate goal of this program is to establish a nationally recognized center of excellence in the training of academic orthopaedic surgeons. At the end of the two research years, the physician scientists begin a traditional five year Orthopaedic Residency. The skills they acquire during their research block are invaluable in their residency and prepare them to make major contributions to the field of Orthopaedic Surgery through careers in Academic Medicine.
Recruitment and Selection Criteria
The recruitment and selection criteria used to choose for the Physician Scientist resident are the same as for the traditional residency program. However, candidates for the physician scientist program are interviewed separately from the individuals who are interested in the five year program and are screened to document their research experience and their interest in a career in academic orthopaedic surgery.
The Department of Orthopaedic Surgery collaborates with more than 40 physicians and scientists in 15 clinical and basic science departments within the Wake Forest University School of Medicine. In addition, collaborations are possible with faculty in the Center for Nanotechnology, the Institute for Regenerative Medicine, and the Virginia Tech School of Engineering in order to provide a wide range of potential research areas for the physician scientists to pursue. Every aspect of the biology of musculoskeletal system as well as more traditional biomechanical studies can be addressed by participants in this program.
The first two months of the program allow the physician scientists to discuss potential research projects with training program faculty members. Although the physician scientists may have their own research project in mind, they need guidance in selecting mentors and in defining research goals. Physician scientists attend weekly departmental research meetings, during which they learn about the ongoing research projects within the department. The physician scientists attend these weekly meetings throughout their training, and at each meeting, they report on their weekly activities. Using this mechanism, the physician scientist research findings are discussed in detail within the context of other ongoing and proposed research. In addition, this research meeting provides a setting in which the first year physician scientists learn from the second year physician scientists.
After identification of their research project(s), each physician scientist and his/her mentors develop an individualized research plan. The research experience is tailored for each physician scientist based on their background and research interests and research funding available. The program is designed to provide an intensive research experience with an emphasis on instruction in the scientific method, methods to enhance research productivity, course work, seminars, Orthopaedic conferences, and research presentations. Physician scientists are evaluated quarterly to assess the progress of their research projects and their participation in the educational component of the training program. The Program Directors ensure that the physician scientists present their research findings at national meetings such as the Orthopaedic Research Society, the American Academy of Orthopaedic Surgeons, the Orthopaedic Research Society, the American Society for Reconstructive Microsurgery, the Orthopaedic Trauma Association, the American Society for Sports Medicine, the American Society for Surgery of the Hand, the American Association for Hand Surgery, The Eastern Orthopaedic Association, and any other basic science meetings relevant to the trainee's research interest.
Please contact Thomas L. Smith, PhD, Associate Professor, Department of Orthopaedic Surgery at (336) 716-2093 if you have any questions regarding this program (Hyperlink).
Literature Cited
Clark JM, Hanel DP. The contribution of MD-PhD training to academic orthopaedic faculties. J Orthop Res 19:505-510, 2001.
Hurwitz SR, Buckwalter JA. The orthopaedic surgeon scientist: an endangered species? J Orthop Res 17:155-156, 1999.
Recent Resident Research Awards
RESEARCH REQUIREMENTS FOR RESIDENTS
During the course of the 5 year residency program, each resident has time allocated to research and is required to complete at least one research project by the completion of their residency training. A manuscript describing their research project in publishable form is submitted to the Education Committee in the spring of the chief year. The project can be either clinical or basic science in nature. Residents who have a strong interest in a specific area of research are encouraged to pursue their interests.
1. All PGY1 residents receive a list of the ongoing research projects in the Department of Orthopaedic Surgery. This list contains the titles of both basic science and clinical research projects. Residents at this level are encouraged to consider participation in ongoing research in an area of interest, or alternatively, they may develop individual projects.
2. PGY1 residents rotate in the Research Laboratory for one month during their internship year. During this time, they are able observe ongoing research activities and to learn the current techniques being utilized in the Wake Forest Orthopaedic Research Laboratory. Residents complete the specific activities described in the Resident Rotation Checklist. In addition, residents attend weekly departmental research meetings. By attending these meetings, they learn about the various ongoing and planned research projects in the department.
Goals and Objectives:
1. Become familiar
with research planning and techniques
2. Become familiar with ongoing research in the Orthopaedic Research Laboratory
3. Become familiar with the research resources available in the Orthopaedic
Research Laboratory and learn how to assess these resources.
4. Choose a tentative area of research interest and identify a mentor.
Resident Research Rotation Checklist
The Use of the Computer in Research
Residents work
with Cindy Livingston to learn how to design data forms for the efficient collection
of study data. Residents learn how to collect data, verify data, and code data
forms for data entry. Because computer technology is constantly evolving, Mrs.
Livingston
provides computer instruction concerning the operation of new equipment and
software as itis upgraded.
Practical Epidemiology and Biostatistics
Residents spend time with a biostatistician in the Department of Public Health Sciences. They learn how to design successful research projects including issues associated with experimental design, power calculations, and statistical analysis of study data.
Prosthetics/Orthotics
Residents attend two clinics with the orthotists who work with the Department in order to learn about the different types of prosthetics/orthotics used for diabetic foot patients pediatric cerebral palsy patients, and other patient groups. They also learn how these devices are fabricated and fitted.
Electromyography Lab, Department of Neurology
Residents attend two clinics with Francis Walker, MD to learn about the use of EMG and ultrasound in the diagnosis of neurological pathophysiology.
Radiology
Pediatric: Residents spend one day with pediatric radiologists to learn about radiological techniques that are used in pediatrics (e.g. ultrasound). They learn how to order the tests and to interpret the results.
Adult: Residents spend two days with radiologists to gain more specific knowledge on the interpretation of adult imaging studies including arteriography.
Physical/Occupational Therapy
Residents spend three days (one in sports, one in hand, one in spine) at CompRehab working with the therapists and observing sports, hand, and spine therapists as they treat patients. They become familiar with the different therapy protocols that have been developed for specific patient groups. Residents spend one day observing inpatient rehabilitation procedures at the WFU Baptist Medical Center PT/OT department to observe the therapy ordered by the Department of Orthopaedics as part of the post-surgical rehabilitation protocols.
Microsurgery Course
Residents complete the Microsurgery course during their research rotation. The course is arranged through Jianjun Ma, MD, PhD in the Surgery Research Laboratory. The course usually takes 2 to 3 hours to complete but will be tailored to meet each residents learning rate.
Orthopaedic Extremity Laboratory
Residents spend time in the Orthopaedic Extremity Laboratory where they learn how to perform an isolated cold stress test with laser Doppler fluxmetry, laser Doppler perfusion imaging, and vital capillaroscopy. They learn how these tests evaluate microvascular perfusion and how to interpret the test data.
Casting Techniques
Residents work with the cast technicians to learn how to apply the commonly used casts.
Participation in Ongoing Research
In addition to their own research project, residents may assist with one project that is Ain progress@ during the time of their rotation. A list of current projects is provided to enable them to choose a project of interest to them. Participation in such a project allows the resident to participate as an author of an abstract or manuscript.
Animal Model Studies
Residents spend a day with the technicians and residents in the laboratory to observe research involving the use of animal models. They may choose to work with an animal model for their research project. Residents complete the Animal Care and Use Examination "on-line" so that they are approved for working with animals during their residency.
Outcome Studies
Residents complete the "on-line" program required to receive a Certificate of Clinical Research Conduct. This program satisfies all Institutional Review Board and HIPAA guidelines and provides the certification necessary to work with patients enrolled in study protocols or to access patient data through the Department of Medical Records. Residents spend time observing the departmental clinical project managers. They learn how data is collected and what happens to the data after it is collected. They learn how to conduct patient interviews and the strategies required to ensure that all data is collected at each visit.
Case Reports
In addition to the other research activities, residents are encouraged to prepare at least one case report. The topic for this report will be chosen by the resident. Faculty members can also assist with identifying potential case studies.
1. PGY2 residents finalize the goals of their research project during this year to ensure the most efficient utilization of time during the basic science/research term of the third year. Residents attend one departmental research meeting in the Orthopaedic Conference Room to discuss their research plans. Attendance at this meeting enables them to begin work on their project as soon as their Basic Science rotation during PGY3 begins.
2. Residents write a research protocol for either a basic science or clinical research project. The protocol includes the following elements: Background and Significance, Specific Aims, Methods (if clinical they include patient exclusion and inclusion criteria), Data Analysis, and References.
Goals and Objectives:
1. Finalize research
plans, with the goal of a publishable paper at the conclusion of the residency
program.
2. Present research plans at Residents= Research Day
3. Write a research protocol
BASIC SCIENCE ROTATION STRUCTURE
During the Basic Science rotations, PGY3 residents attend the weekly departmental research meeting in the Orthopaedic Conference Room to discuss the progress of their research. Residents maintain a regular schedule to work on their research projects. The rotation is composed of two 2-month rotation blocks. Residents submit weekly status reports to document their activities during each week of their research rotation at the weekly research meeting.
Anatomic Dissections
PGY3 residents also are responsible for occasional anatomic dissections for Core Curriculum as well as various hand conferences. PGY3 residents are also encouraged to use free time to further understanding of commonly used surgical approaches, as their responsibility level during the PGY4 year will be significantly increased in terms of cases on service rotations. Dr. Shilt is the contact person responsible for obtaining cadaveric specimens for individual dissection. Residents are encouraged to share their dissections with fellow residents as time allows.
Tumor Conference
PGY3 residents on the basic science rotation also are responsible for weekly tumor conference on Wednesdays at 6:30. Topics for this conference are available in advance from Dr. Ward=s office. Dr. Ward=s clinic secretary has access to his patient database should slides for case presentations be requested.
Goals and Objectives:
1. Significant progress should be made on the individual resident=s research project during the basic science rotation.
1. Residents continue work on their research project.
2. Residents attend one weekly departmental research meeting between July-September and one meeting between January-March to report on the status of their research project.
Goals and Objectives:
1. Continue work
on individual research projects.
2. Report progress twice during the year at the weekly departmental research
meeting.
1. PGY5 residents
prepars at least one manuscript for publication. This publication describes
their research accomplished during their residency.
2. Each resident attends one weekly departmental research meeting between July-September and one meeting between January-March to report status of their projects.
Goals and Objectives
1. Completion of
project and manuscript prior to completion of residency training.
2. Presentation of completed project at Resident Research Day
Each spring, the Department of Orthopaedic Surgery sponsors a Resident Research Day. Residents (PGY2-PGY5) present their research during a scientific session. A visiting professor from an orthopaedic subspecialty is chosen each year to participate in this research activity. The format of resident presentations vary according to the residency year. PGY2 residents may present their plans for their proposed research project because they probably will not have started to collect data. However. PGY3 residents may be able to present preliminary data. If preliminary data is not available, they may present an update of the progress on their research project. PGY4 residents will present preliminary data. By PGY5, the research project will be in manuscript form ready for publication so that residents at this level will be able to present a comprehensive review of their research project. The residents and visiting professor are honored at a dinner the evening that follows the scientific session.
In the fall, the Division of Surgical Sciences sponsors Residents' and Fellows= Research Day. A visiting professor from one of the surgical specialities is invited to participate in judging the posters. The visiting professor also delivers a keynote address to members of the division. Residents and fellows display posters describing their research and compete for prizes. Winners are announced at a dinner to honor the residents/fellows and their mentors.
Summary of Clinical Research
Initiatives
Department of Orthopaedic Surgery
Wake Forest University School of Medicine
This is not an exhaustive list of current research studies but is designed to highlight the general areas of research and the diversity of research endeavors pursued by the faculty and residents in the department of orthopaedic surgery.
Summary of Basic Science
Research Initiatives
The broad area of myoneural control is currently under investigation. One of the primary questions involves neuromuscular junction stability, which is dependent upon the motor neuron, the neuromuscular junction, and the muscle fiber. Current studies encompass all three components that contribute to neuromuscular junction stability.
Microvascular/Exercise Studies
Other Research Initiatives
Collaborations
with Industry through the NIH Small Business Innovative Research (SBIR) Grant
Program
SBIR - Diabetes
Spectral analysis of laser Doppler fluxmetry signals indicates a difference in diabetic patients compared to non-diabetic patients with respect to the autonomic control of the cutaneous microcirculation of the feet. This SBIR, in conjunction with Transonic Systems, Inc. (Ithaca, NY), is supported by NIDDK and examines the feasibility of using this type of device for clinical applications.
SBIR - Millar
Hemodynamic measurement techniques in mice are being constantly refined in response to the needs of the scientific community. Collaborations with Millar, Inc. (Houston, TX), manufacturer of the world's best pressure measurement systems for clinical and basic research needs, were the basis for a funded SBIR proposal to create mouse-sized pressure sensing catheters with diameters of 300 microns. These devices are now in development and assessment of size and fidelity requirements are ongoing. In addition, ventricular pressure-volume techniques for mice are being further refined and used in this laboratory.
MEETINGS/COURSES
Sponsored by the Department of Orthopaedic Surgery
Wake Forest University School of Medicine
The Orthopaedic Laboratory also organizes and executes several courses and conferences on an annual basis. These meetings/courses are described below.
Microsurgery Course (Jianjun Ma, MD, PhD)
A structured course in microsurgical techniques is offered to hand fellows and orthopaedic surgery residents. This course lasts for 4-6 weeks and provides a step-by-step approach to teach the use of operating microscopes, microsurgical instruments, and microsuture knot tying. Top-quality operating microscopes and microsurgical instruments are used for this course to replicate the instrumentation and equipment used in the operating room. Specific techniques for microvessel (artery and vein) anastomoses, and nerve repairs are demonstrated. Students learn these challenging techniques by performing repairs of small (1 mm and smaller) arteries, veins, and nerves of rats and mice. Students also learn how to assist microsurgeons and work as a team utilizing dual observer operating microscopes to perform vessel and nerve repairs.
Southeastern Fracture Symposium (http://www.sefs.org)
This course is hosted by the trauma team each year during January and was developed to provide updates on the latest orthopaedic trauma initiatives to orthopaedists, researchers, research associates, fellows, residents, physician's assistants, nurse practitioners, nurses, and operating room technicians. The objectives of the course are to: discuss current and preliminary research studies related to fracture management and trauma care and to identify the recognized best treatments for various types of musculoskeletal trauma. A nurse's symposium is held concurrently with the other courses to educate nurses who work in a clinical orthopaedic setting regarding the most up-to-date trauma treatments.
This course is designed for orthopaedic surgeons, neurologists, pediatricians, physiatrists, fellows, nurses, physical therapists, and occupational therapists who are interested in updating their knowledge on the spasticity management techniques that are available for cerebral palsy patients. The Department of Orthopaedic Surgery has developed a multidisciplinary approach to spasticity management. This course highlights the techniques that are used through this approach to manage spasticity in cerebral palsy patients. The course describes the pathophysiology of cerebral palsy and the resultant abnormalities of neuromuscular function. In addition, the course describes techniques to assess the anatomical and functional impairments associated with cerebral palsy. Finally, the course describes the pharmacological, surgical, and rehabilitative approaches to improving function and health-related quality of life for cerebral palsy patients.
Rat and Mouse Surgical Workshop
(http://www.wfubmc.edu/ortho/research/Mouse_Workshop_Information.htm)
The Department of Orthopaedics hosts an annual Rat and Mouse Surgical Workshop. The goal of this course is to introduce scientists to surgical and physiological monitoring techniques that enable them to examine complex physiological responses. The course focuses on surgical skills, techniques and "tricks" that permit the successful use of acute and chronic instrumentation techniques and hardware in small animals. The course also exposes participants to powerful data collection and analysis software designed to facilitate study of these complex physiological systems. More information regarding this course can be found at http://www.wfubmc.edu/ortho/research/Mouse Workshop Information.htm