Hi everyone, my name is Patricia Zhang. I'm a physiatrist at the University of California, San Francisco, and welcome to our little session here on a Physiatrist's Guide to Clinical Research. We want to help researchers at every stage. I'm already impressed looking at my Brady Bunch screen of people who are here and realize that we have probably a very large breadth of research experience here in this Zoom room. I would just propose that perhaps what we can do is we can rename all of ourselves, our names, our titles, and perhaps whether you are a medical student, a resident, and attending, that might help me kind of reframe a little bit better just this presentation to suit everyone's needs because I can see that we have some medical students here and I would imagine we might have some residents and perhaps some fellows and perhaps one or two attendings. I'm happy to make this as interactive as possible. I was actually gonna invite you all to perhaps also chime in but of course that's not a requirement. We are expecting up to 60 people but from what I've heard from past experiences, sometimes this can be not that many depending on who actually is able to show up, say if their call was busy or not. Perhaps how we can get started here is just to break the ice. Let me go into my presentation, just a little background on what research entails and what resources you might be able to find at your particular institutions or private practices to help access research. And then for the people who stay on, I'm then gonna just invite you guys to join if you want to, maybe turn on your cameras and unmute yourself at that time after I've finished my presentation and then we can have a little bit of a discussion about what particular things we might want to focus the second half of this on to make this more valuable to everyone who's here. So the way I tailored the presentation which I'm gonna share right now is that I figured many of the people who probably would join this session are not yet famous NIH funded, super well cited researchers. This probably is a little bit below your level of knowledge if you're already publishing and you have large NIH grants. What I wanted this to be is more of a kind of a starter kit. So for people who haven't really engaged in a lot of clinical research, what resources might there be for you to help you get going? So we're going to be covering things about, you know, what is research? What does it entail? If I'm trying to come up with a project and I need to get an IRB approval, how can I get that to happen? And then also, you know, what are the steps that I should be thinking about? I think some of us when we think about research, we think back to when we're undergrads and trying to get into med school and med students trying to get into residency and residents get into fellowship and fellows trying to get a job. It's kind of like in that cat fight of trying to get to the next stage. Research is something that you needed to arm yourself with to get to the next step. And once we're at the next step, whether it is getting to fellowship or finally getting an attending job, it's easy to be complacent, right? And for some people that don't enjoy research, this is where they will let research go. But some of us feel a greater calling that really we want to participate in the research arena and contribute to the body of knowledge that we all share and benefit from. And so some people feel like they must do research. And if this is you, then I want to give you a little bit of information about what resources are out there to support you, especially once you are out on your own and there may not be an academic site where you're at where you have easy access to all these available resources. And so if you are now out in practice where you're a fellow and you're just trying to get something going or maybe even a research resident and you're thinking about how to formulate, how to get your project started, the first thing is, of course, just to find a research question. And, you know, sometimes this is hard because if you're still early in training and I see a lot of residents here and a couple of medical students, you might not even know what is the topic that is worthy of putting your efforts in. And I would say this is a great chance to talk to a mentor to find someone who does what you want to eventually do and ask them, like, is there something that interests them and that you think would be a good research topic for you? And, you know, I've been very lucky to have worked with exceptional medical students, even, where I get, you know, they come to me and they have some things in mind. And what really impresses me about a good medical student is that they will go on and do their preliminary research, right? So I have lots of cat pictures because I have found that cat pictures makes everyone happy. And sometimes I think if I give you the most ridiculous example, it helps you to just remember what I've said to hopefully retain some of the information I hope to share with you. So let's just say you are really interested in cats and you're like, I have no idea why my wonderful feline friend can jump so far and jump so high. And if this was your research question, then I think the most important thing, which I see people skip, is that you really want to do some preliminary research and see what's already out there. So and you don't have to do it on just Google Scholar, which is what I did here, PubMed. There's many different search engines. I generally use Google Scholar just because I'm very familiar with that interface and say you wanted to specifically understand what influences a cat's jumping distance. You put it in and then you will see a very large number of 192,000 articles that has come out. And I would encourage you to read the ones that you find most interesting, right? So in this particular study, they actually, it's almost PM&R related, they implanted EMG sensors into these cats' legs and saw what was being activated when they were trying to jump the highest that they can. And this is, we want to be familiarizing ourselves with what's already being studied so that we can really hone in on what is it that we can contribute further, right? So after you do your preliminary research, it's going to really help to narrow down your topic and help you hopefully determine the potential questions you may want to ask. And one particular framework that I like to use is called Finer. I'm not sure if any of you guys are familiar with that. It really prompts you to look at how feasible this question would be. So for example, you might be like, what is the cat thinking when they are wanting to jump very high? Well, unless you guys can read a cat's mind or develop a very interesting and clever idea to try to get at that, that's perhaps not very feasible. Obviously, we want a question that's interesting and novel so that we're contributing to the greater knowledge base in a way that people would want to read about. There's also importance of trying to make sure things are ethical, right? Like for example, if you want to know if a cat could jump higher with one eye closed, and you can't really force a cat to do that, and you don't want to harm a cat while doing something like this. And just eventually, we want to make sure this is relevant. So something that we all would want to know to further science. There's a lot of frameworks you can look up to help you construct the research questions. So research questions can be separate into broad categories, such as quantitative versus qualitative. And you can just read this and say, you know, population is obviously of importance. Quantitative research can have an intervention, whereas a lot of qualitative research, you're looking more at exposure. And of course, you want to really carefully determine the outcome. I would say general, if you're interested in research, it is a little bit easier to find resources if you're an academic site. So I see a lot of, you know, residents and even medical students here, which is wonderful. And if you're an academic site, there's a couple of places you can look at to give you some more guidance. So one would be if you're in some sort of program, then find a mentor. I can't emphasize that enough. But for some of us who are already attending, it gets harder to find a mentor, because you might be a place where there's a lot of clinicians. But if no one's doing research, and you're the first one, then you might need to look elsewhere for some guidance. So if you're at an academic center, then I encourage you to search at your university. So this is what I can find when I go on the UCSF website and just look like research support or whatnot. So here we have resources for investigators, or you can see for pre-study, there's people who you can buy time from, or they can actually help you to develop a protocol by looking at the feasibility of what you're trying to look at. They can help you come up with a budget, and that will might give you some idea of how much funding you might need to apply for. We are very lucky here that our institution helped us make connections with industry. So that's what innovation ventures refer to, as well as find ways we can work with a community. And there's even a Center for Community Engagement if you're really wanting to access a particular at-risk population. If your particular research is very device-heavy, where if you're really proposing a very large trial, then it's helpful to get someone from regulatory involved, because there are specific forms you need to fill out. There's kind of data and safety monitoring that you might need to be aware of. And it helps to work with someone who has that regulatory and inspection experience. And if you're running a really, really large trial, you actually need a pretty large team to help with data management, to make sure everything is safe, to do the billing, and make sure you're on track financial-wise. Here there are certain, and you can look to your academic site, like can you ask for a consultation with some sort of clinical or translational research institute? Because often you can ask for a free consultation here. We usually have one hour free. Sometimes if you're in a training program, your department may actually be able to pay for you to access these services. And one thing that's particularly helpful for, say, medical students and residents who may not have a lot of biostatistical background, is that you can actually pay for someone to help you design the statistical method. And they can often point out like, you know, this is the statistical test you can do. And there are free calculators out there where once you know what you need to do, you can then do it yourself and have faith that you're doing it correctly. At an academic site, it's really helpful because we do have institutions to help us make sure things are safe. So we have an IRB website here from our institution. And if you go on to it, you can go to the help site. And for us, they can actually walk you through the IRB process. Also, we have access to specific human subject training for researchers. So there's CITICity online training. And even if you're out by yourself, you're attending a private clinic, if you were really set on doing research and you don't have an IRB institution at your private clinic, I would encourage you to look up CITICity training. And it gives you a lot of guidance about this is why we need to fill out an IRB to get institutional review board review. It tells you a little bit about like, what are the steps? What are they looking for when you're going through these IRB processes? So that kind of transitions me to also covering some things that might be available to private practice providers, people who don't have this academic institution to back them up. Things that are out there is, of course, AAPMR supports such efforts. So if you go on the AAPMR website, it's actually sorted under residency resources, but they do have some good information about getting started with research. So there's a little bit about what I discover. So like looking into a research question, doing some preliminary research reviews, they do cover grant opportunities, and I'll get to that a little bit later too. Especially if you're a medical student, they have some specific resources on that, and even how to write for a grant application, which is really needed because honestly, half the battle of research is getting the time and also the money to do what you want. The other really broad resource I would point you guys to would be the Association of Academic Physiatrists. So for attendings where you don't have a lot of resources at your institution, I would recommend you to look at this Physiatric Research Consulting Program. So if you have some idea of the type of research you want to do, then you can actually go to the website implied for a consult, and they can actually walk you through some of what you might be grappling with. If you are a medical student, then I very much encourage you to look into this RREMS, Rehabilitation Research Experience for Medical Students. I think they have another one that's more geared at people who are already in residency, but it's a pretty structural program. And again, it's about finding a mentor who's gone through this before, who can really mentor you and guide you. For my attendings out here in this Zoom room, if you're looking into doing clinical research and it needs IRB approval, there are external IRB sites. So WCG is one that I've actually personally interacted with. And depending on what type of research you're doing, from a large trial to something small, where it's just injection research because I'm a spying physiatrist, it can range from somewhere from $5,000 to maybe $20,000, just given how complex your protocol might be. But I would just encourage you to look at them. And you can even get usually a free consultation. So if you email them what you're doing, you can set up a Zoom call usually, and then you can describe what your project is, and they can give you a more specific quote. Speaking of money, as I mentioned, half of research is making sure you find the time and the resources to do the research you want. Even if you're a medical student, or if you are a resident, often at their academic site, there's funding for like a summer internship, or just for a little bit of dedicated time to do the particular type of research you want. There's sometimes department and clinic funding. Foundation of PM&R, which has a collaboration with AAP Mar, they offer a bunch of grants that's between $10,000 to $30,000. And depending on your particular research, and I'm a spying physiatrist, I'm most more familiar with the pain and spying field. There's many societies, and often these societies would also have some small funding opportunities you can apply for. And of course, there's large NIH PCORI grants where you can get millions of dollars for the projects you want, though often they require some preliminary data and for you to have research experience. So if this is something you want to, you're probably pretty established in research already to be applying for this type of grants. For the attendings out here, it often helps if you have a student to work with you, because if you find a project that a student is interested in, and you're interested in, then it helps you to mentor them, and it also helps you to do the research you want. So pre-medical students I've worked with, and they're wanting to get into medicals too, and they're very, very motivated. I've actually had some pre-medical students who are great programmers already, and they've been very helpful in some sort of like the app studies that I've worked on. Medical students and residents again often have dedicated research opportunities, and sometimes they are even paid by the institution to do research during that time. So if you can partner with those programs, you can often find really dedicated students and trainees who can help you complete your projects. But I think I always like to think of working with students as they're making a commit to you, but you're also making a commitment to them, right? So it's not like herding cats and just letting them take the project and going where they want. It's very much about like meeting them, making sure that we have you know that both parties are invested in this project and find this project interesting, and setting very clear milestones and checking in consistently over the time period you're supposed to do this so that everyone is benefiting and moving and things are not getting stuck. Well, I gave this talk to my own colleagues at my institution because not everyone here actually do a lot of research. Some of us are very teaching and others are clinically focused. I got a couple of questions that I just wanted to cover here as well, especially for the attendings, there may be a question of like, does my QI project also function as a research project? And so at our specific institution, we've asked our review board this as well, and they of course say yes, a lot of research projects may have even started as QI projects. So for example, I'm doing some research about how to improve multidisciplinary care for back pain patients. And some of the thought process is that if we, for example, as physiatrists do the screening first, we can help the patients go to the right place. And that first started as a QI project here. So often what happens is in this transition between a QI project and a research project, you may eventually want to get IRB approval. And that's because a lot of times when you're submitting a paper for publication, the paper, the journal that you might be submitting to may even ask to have you provide your IRB approval. And so especially if you're doing something that involves testing, you know, if you're involving something that will even be a publication, that probably needs to go through IRB. And the second thing is no matter what, even if you're trying to do it, say for QI purposes, if you're testing the safety and efficacy of a drug or device in a human subject, that is by definition a research project, you definitely would need IRB approval. Another question that came up is, you know, like what if I'm not trying to write up a study or a trial? I'm just interested in publishing my interesting case as research. So here is apparently a picture of one of the cats that's been voted the most ugliest cat. This is called a sphinx, and it's a breed of cat with a natural genetic mutation where they just don't have hair. Let's just say you saw the ugliest cat and somehow you want to make this into a case presentation. That's usually fine. At most academic institutions, we actually have pre-designed forms where you would give the patient, if you knew the patient, a form just to have them sign off on things if you can. If it's being completely de-identified, sometimes you don't need to do that. But if you could do that and have the form signed, that's usually encouraged by academic societies. So you're basically disclosing to the patient that, you know, this is a very interesting case. Would you mind if I shared it in a de-identified manner with the rest of the medical society so everyone can learn from it, and if they're okay with it, they can sign a form. But the whole purpose of research is that once you have found some interesting insight, we need to make sure that you actually publish it so that other people can benefit from your research. So dissemination-wise, you know, of course, AP MAR, there's the annual assembly, and you can submit your findings as abstract, AP, ACRM, other physiatry organizations, you can, they often have annual assemblies, and you can submit your paper as, or your findings as abstract. And I think the goal for a lot of research is eventually to actually write a paper so this can be peer-reviewed, and then once it's published, then it can help to guide the next generation of scientists. And so a quick presentation here, I obviously, I'm just touching very, very high-level topics. I think for me, you know, if you have the motivation to do research, I very much want to applaud it. I know AP MAR would want to as well, and so hopefully you got a little bit out of that presentation. I invite you, if you want to perhaps turn on your camera and unmute yourself. I think it may be helpful, and because I'm hoping that you guys are all across, or coming from different institutions and whatnot, if you want to introduce yourself, and perhaps to state what level of training you might be, and what type of research you are, like what field of research you might be particularly interested in. We can make this kind of a little bit of a discussion. If you have any particular questions, I'm happy to take that as well. Sometimes when you're in a Zoom room and you're giving a presentation, it's like asking the question, if you're in the forest and you cut down a tree, can you really hear it? Because I'm not sure who's out there. Oh, I see some faces. Hello, hello. Any brave souls, just go ahead, introduce yourself, what stage of training you are, and also perhaps what type of research you might be interested in. Hi, I'm Deanna Lewis. I am a second year medical student. I actually had a question. I think earlier in your presentation, you were talking about constructing the research question, and the components of quantitative versus qualitative research, and I just wanted to go back to that and just get the notes that I didn't get earlier. Yeah, yeah, happy to. So let me just go back to that slide. Let me see here. Are some of you guys from the same institution, perhaps? No, not sure. Yeah, I mean, there's a lot of guidance out there. So I think I mentioned AP has a website as well as AAP. You can actually go onto those websites, and they have even more in-depth overall guidance about how to construct research questions. And there's actually really good books out there. And if anyone's interested, I can send things out. Or if you email me, my email is just my first.lastname at ucsf.edu. I don't know if that's already shared with you, but happy to interact with any of you guys on a one-to-one basis. Any other thoughts, questions, people who want to say their names and level of training, and what type of research are they interested in? I might call names of people who are. Okay. Yes, Deanna? Yeah. Do you have a particular question about the slide? Oh, no. I was just going to say like some of the research that I'm kind of interested in, or just like exploring for the most part. So I recently have been looking into like the spinal cord stimulator implants, and just was trying to gauge like who else would be interested in that and any advice on how to go about getting into a little bit more research for that. Because I know it is a bit broad and kind of like a newer concept that is being used within procedures. So I just figured I'd throw that out there and see if anybody else was interested in that research as well. It's awesome that you have a particular topic in mind already. Any takers on spinal cord stimulators? I think I see a lot of medical students with their videos on. So as a medical student, it often helps if you have a PM&R program. I don't know if all of you guys do. I don't know if all of you guys do. I actually came to a medical school, UCSF actually, that at that time didn't have much of a PM&R program. Like we don't have a department here. And only recently did we get a section. So I think it is okay to cold email people. People are going to be impressed if I got an email from a medical student that they want to do research in my particular field because they read a paper of mine. That usually would make me interested because that's a lot of initiative right there. So one is if you have a PM&R pain department division section and you know someone there. So I would maybe Google like the department and look at their profiles and see what they have published on and read one of the papers. So you can email an intro and say, I read this paper and that's really interesting. And then ask to me to discuss. Or if you really are at a place where there's no such resources, then I would just literally do some PubMed search. Find some good papers in the field that you're interested in and reach out to the contact email. Because they're going to be pretty impressed that you as a medical student took that much initiative and you know read their paper. And they might just be very willing to give you a one-hour conversation to point you the right way. I mean, I don't want to. It's not a class. I'm not going to first call anyone. If you want to say your name and training and what you're interested in, that's totally fine. We do have a question from Cesar about, do you know of any travel grants available with APMR or AAP for fellows? Now, I don't particularly know. I know there's someone who's a representative from AAPMR here. I don't believe there's travel grants. You can apply for funding, right, for foundation of PM&R. For foundation of PM&R, they have grants. Okay, so that I also don't know. I would say if you were at an institution like my medical students, the residents I work with, once they have something accepted as a poster or especially if it's a podium presentation, there are travel grants. So either through their GME office, if you're a resident or fellow, or if you're a medical student, then it's through the School of Medicine. And maybe we've been particularly lucky here, but once you get something accepted, they have a pretty high chance of finding some funding for coverage. If you're attending or if you're a fellow at a private clinic, that might be harder. For smaller injections societies, so it might be the same thing if you were interested in spinal cord injury and there's a spinal cord injury clinic, I'm sorry, spinal cord injury society or a brain injury society. If there's societies, if you're a trainee and you get something accepted, then often they can waive your registration fee. If you get a podium presentation for the societies that I'm part of, as a medical student or a resident or a fellow, often you can have even some support for travel. That's as far as I know. And there may be other things. If you guys know of anything, you're more than welcome to chime up so we can share our knowledge with CSER. Any other questions? People want to introduce themselves. Oh, go for it. Hello, everyone. My name is Dwayne. I'm an MS3 from Ross University, IMG. I'm heavily interested in physical medicine rehabilitation. I'm currently working on a case on acute transverse myelopathy, and we believe it's secondary to cocaine use. And I'm not too sure if there's a lot of things, a lot of research behind that. We've been looking. And my question is, how important is research, published research versus research in the works when it comes to residency positions, or a student applying for residency? Okay, the question was, how important is published research? And then what was the other thing for applying for residency? In terms of published research versus research in the works. So if a patient, if a student's working on it versus it's published. I think there's two things because, you know, when I was a resident and fellow, we were part of the admission committee for my residency. And I can talk a little bit about my experience about that. And I know there's other attendings here, so they can chime in too. But you get two things when you do research as a medical student. First, you get more familiar with the topic and make sure this is something interesting to you. And then two, yes, it's to help you get to the next step of your career. Remember the cat picture, you're still kind of in a fighting zone and you want to get to the point where the cat can totally relax. So that helps in a couple of ways. So if you do research, even if it's not published, you can talk about it, right? You could say, I did my research. I'm writing up a case report that shows you took initiative. Obviously, if it's published and you can put it on your CV and that's an added bonus. And then I would say, it sometimes can take a while for a paper to be published, even a case report to be accepted by a journal. I really strongly encourage you, your MS3, to submit one of the abstracts to one of the upcoming society meetings. So AAP Mart recently passed in March, the abstract submission cycle. The next one usually will be AAP. I mean, there's many other ones, but I'm just saying AAP is one of them that usually comes out in the fall. And of course, you're still early in your career, so you could even submit again for AAP Mart next year in March, something of 2025, right? I would really strongly encourage you to do that. Usually, the bar for getting an abstract accepted at an annual assembly is not extremely high. And so I would hope that you will have the opportunity to present and then to go there, which again is another line on your CV to just really prove to the people that you're applying to that you're interested in BM&R, you know why you're interested, and that you've taken a lot of initiatives to get yourself ready for society. Oh, yes, Jill. So I'm coming in at the very opposite end of the spectrum. You can tell by my gray hair and my reading glasses. And I have recently retired and I did not do much research during my career. I was working in private practice, you know, seeing patients, seeing patients. And now I feel like, you know, I know things and I want to write them up. And I was one of the reviewers for all these abstracts that are being reviewed for the different levels at the AAPM and our national meeting. But I probably, my biggest question is, I've done mostly industry studies because the multi-group practice that I'm in, you know, those are funded. And I will say, though, that it's very hard to get your personal interest things funded. And if you have any advice on how to go about doing that, that I would appreciate. Yeah, I mean, thank you for the interesting research. You have a wealth of experience that we would all benefit from. But I hear what you're saying. I mean, it is hard to get grant funding. It really is. It's almost easier to get industry funding because industry is motivated. If you have a personal project, it takes a lot of work. I'm right now applying for R01, which is an NIH type of funding mechanism. And the amount of work and the many meetings we've had, it's just like sometimes I'm like, this is a full-time job, right? So I would start small. And small means finding a society with interests that mesh with your interests. The smaller, the better. Because I've been part of smaller societies and reviewed, you know, grant applications. And, you know, because the school is smaller, people know and think alike, they're more likely to fund you. But these are probably smaller grants, like maybe 10, 20, 30,000. But it's enough to get you going. And the thing is, like, you build yourself up to like large R01s or like U19s or like really large PCORI grants, right? Like you've got to have a lot of existing body of research before you can get there. So I would say find small, small organizations, join them, apply for the grants. Foundation of PMNR, actually, I've been lucky enough to get a few of those grants. I think they're very open to working with you. So especially if you're a reapplication, let's just say you didn't get it that first year, I think people look favorably upon that. Like you can take their feedback and they try to give you some feedback. And if you were to go through the cycle again, it really shows that you care about this and you're trying. And I think that is a motivator for them to fund you, right? But then also I met some really ingenious researchers that are able to come up with things that hardly need any funding. And, you know, systematic reviews, for example, doesn't need funding. If you are going to send out a survey and you have the mechanisms to do the statistical studies yourself and write it up, those type of research do not need a lot of funding. So sometimes it's also being clever about how to think about your particular research question to really decrease the amount of resources that's needed to get what you need done. Awesome advice. Thank you so much. I hope it helps. Other people you want to introduce yourself? I had a quick question. I'm Kate. Nice to meet you. Thank you for this talk. We all appreciate it, especially. I'm a med student currently third year in Michigan. And OK, my question is kind of broad and definitely more case by case dependent on the research. So I don't know how valuable this question will really be. But in my experience, trying to find research and get involved. A lot of it was dependent on location and availability of my time during clerkship or whatnot. And so I'm just wondering based on your experience and other attendings and whatnot that you've worked with, how common it is for students to reach out that are not in your location in kind of working virtually on studies. And obviously that really depends on what the research is and whatnot, but just kind of want to know your take on that. Yes, let me share with you my personal experience, which might be different and other attendings can chime in. I generally, if I get an email that really looks like they just popped in names and emails and it's a very generalized blast, I do not take the time to respond. I mean, there's people who are very well-qualified. You glance at their email like they're like PhDs with publications and whatnot and they want to do research. But clearly that person didn't put a lot of thought of it. I don't know how they got my email, but I'm not going to take the time to respond either. What I would respond to is if you say like, you read one of my papers and you are interested in a specific field. You don't have to read my paper, but I'm just saying like you took the time to do the literature research and to actually look into the publications and maybe even have an idea of what you want to do research in. Usually I would say I generally at least offer a Zoom meeting if it's in my field of interest. And sometimes I have to tell you, I've told the student this sounds like a great idea, but I don't know exactly how I can support you here. So what may be some of the issues of my working with a medical student who's not at UCSF? One, my IRB applications have to have the student have a UCSF email to be part of. So like say I'm doing one of my studies right now is looking at an injection app and trying to see what's the outcome after spine injections. But for a student to help me, they need to be on this IRB and I can't add them if they don't have a UCSF email. So when I've done, as part of another society, we were doing this class where we take residents and fellows and we try to get them research projects. For them, we are guiding them to doing an IRB at their site, which takes a while. It's not gonna be something that's gonna be done in a week or two. This is gonna take like six months. And then once they get the IRB going, they're gonna recruit at their own site. That's usually what I've done if I have to work with a student at another site. And we're gonna have to do systemic reviews, which some people are very interested in. I'm not a huge fan of systemic reviews myself just because I like more clinically focused research, but you might be wanting to think about those kinds of things, right? So one is if you do know exactly what you wanna do and you know these are the people who do what you want, then I would very much write a personalized letter, not like a generic mass blast because people don't tend to respond to those. And then if you are gonna think about a particular research project you can do with an attending another institution, I would encourage you to think about something that you could either do an IRB at your site and recruit for, or some sort of like either survey based project or systemic review where you wouldn't need to be on someone's IRB because that may be hard. Great question. Hi, I'm John. I'm a third year medical student as well. I'm up in Rochester, New York. So my question is two of the local hospital systems here have a PM&R residency program, which is wonderful. The bad thing is one of them isn't as academically focused so that there's not a lot of research possibilities there. How do you kind of battle that into getting research done? Because I've worked with the one program, I've already done a rotation there and I've asked the clinicians, people involved in like the PM&R residency program about research. And it doesn't seem like they have a lot of options for that. Even getting like a case report for something, it's been difficult. How do you navigate the situation? I mean, it's hard. Yeah, I mean. It's very difficult. I've been in my P's and Q's. I've asked like my residents, the fellows, there's rotating medical, there's rotating like residents through the program. So I've asked everyone just like, so you see me on anything? If you see any interesting, let me know. But the population we're kind of working with doesn't particularly have like a lot of interesting outcomes, a lot of interesting presentations. So it's very hard to do a case report. You know, it's where we're just really treating people, helping them get better. That's kind of, so. Which is equally important, right? Like we want to be- It's great. Yeah. But I hear you. That is hard. And that was kind of my issue when I was a medical student because here we have quite a few physiatrists now, but when I was here, there was no one doing a lot of physiatry care. So no one was interesting research. I don't know what would be the best guidance because like what I said in the presentation, I really feel like you need to feel a calling to do research once you've graduated. Some of you guys, especially though, it sounds like there's a lot of medical students here. Like you're kind of still in the cat fight. So like doing research is like arming you with like things on your CV to get to the next stage. But once you're attending, if you have no incentive, financial incentive to do research. And in fact, as we heard from Joe, it's hard for us to even find funding to do research sometimes. Then it gets a little bit harder. I myself, I'm not sure why I can tell you to motivate the people at your nearest residency to do research. I would say either you're going to have to go and look into those AAP MARA or AAP programs where you can find a mentor elsewhere, where you can do a structural program to do research, or it sounds like there's another residency that may be more academically focused. Maybe you should reach out to someone there and make some connections. So one question that I had, as I'm getting mentored by a fourth year student who recently got accepted to residency, a lot of what he said, and I kind of want to get your feedback about this, was essentially doing a project on your own, like a poster, because like something simple, and then kind of cold emailing physicians to see if they're cosign off of that. I don't know how feasible that is, nor if it's... That is very interesting. That has never happened to me yet, where someone emailed me, say a poster, and want me to just sign off on it. That's interesting. So his approach- But listen, if you want to submit something, I will look it over and I will sign this thing. I mean, it sounds like you're more aiming for a case presentation. I mean, like a case report, right? It doesn't seem like you're actually going to get IRB and do something. I feel like we, I mean, if I can't, if your subject matter is something that I really have nothing to say about, then I will try to find you someone, because I'm sorry this is happening to you. But also, I would say this is more incentive for all of you guys to go into PMIR and do research. Yeah, but I would, I'm really kind of shocked if you wrote a poster and you asked one of your attendings if they could just participate with you on it. You don't think they would? I think, no, I mean, a few of the things I've worked with would definitely do it. I just don't know how inclined it would be to be like, yeah, hey, no, we'll keep doing this. It's been hard to just get like a case report. And, you know, I'm motivated enough to do it. It's hard enough to find a subject matter that is feasible. Yeah. Yeah, and I'm happy to take this feedback to a PMIR and see if there's, maybe I'm just not available, aware of resources we already have, but maybe there is need also for some sort of mentoring program or if this is something you're interested in, we might be able to identify some physiatrists who might be able to aid you on that. But John, for your purposes, if you really can't find someone, you can message me, especially if you have something particularly in mind. I'm not a very, I'm no longer very well-versed in general physiatry, but I can at least try to see if I can find someone who could comment on whatever you're writing up. General physiatry is actually the field of most interest. I really like the inpatient side of it. I've been in outpatient pain and spine, and that's cool to see all the procedures and the pace of it. And it's great to listen to the patient stories about how they're dealing with their pain. But something about inpatient just really kind of tugs at my heart where I'm like, this is where I want to be. Well, we need people like you. Yeah, and I know some inpatient general physiatrists. So if you send something over, let me see if I can identify someone to point you in the right direction. Thank you. Any other thoughts? I don't mean to keep all you guys until 5.15 my time. It's just a chance for any of you guys to meet each other. That's why if you wanted to state your topic interests or whatnot, it might help to find collaborations. And I'm happy to answer any other questions you guys have. Yeah, I can go as well. I'm a fellow New York state medical student and down in Albany, Albany Medical College there. My name is Nathaniel Haycock. I'm a third year, also interested in PM&R. I've been lucky enough to take some of the steps that you've mentioned, including my finding a mentor and starting a project. But I've definitely run into some of the issues that you mentioned, John. Like there's just not that much research like going on already. So the people that I talk to, whether they be like residence fellows or attendings are all like come up with your own project and we will support you to do that. But then of course you run into the issues of student time, especially with third years on rotations and just continuing the project over the years. I can say that the one thing that's worked for us is developing teams with students who are both like in their first years and second years and third years and maybe with like a resident to kind of oversee it or intending to help out with that because that provides some continuity and then they can recruit new students as well over time. My research interests are in kind of the psychoneurobiological realm. I'm really interested in that, like my body connection. So I've worked mostly with chronic pain patients and looking at how their expectations about a treatment influence how well the treatment actually works going forward. So thank you for the presentation. It was really interesting and it's really nice to meet all of you. I mean, this group has been more medical student focused. You guys are just so early, I'm so impressed. I thought maybe we'll have some friends and some fellows, especially given that we kept this topic pretty late. But I think maybe one thing that may help is if you're a medical student and you share the struggles of John and Nathaniel or maybe even if you're a resident and it's hard to find some mentors for you you can message me. Maybe we can just have a poll of how many people that would be. Because there's other injection society I'm part of. We do have a research mentorship class. And so what happens is some of us would actually select the cohort of students. Many of them are residents and some are fellows. And we will basically kind of have fixed check-ins to get them through a project. So that's one thing that we can do. So the latest one, we've actually formulated a project that the students were interested in and then submitted IRB applications at all their individual sites, which then helped them get used to what that entails and what the process is. And then we're guiding them. It's a two year thing. Last year we did a one year, but it ended up being a little bit rushed, but it ended up being this kind of cohort. And that way we could teach them like all the steps of research and guide them through it. And if there's something you guys feel like there's a need for, perhaps we can somehow make that known so that we can maybe go back to the society and ask for some support. Is that something you guys are interested in? I see some nods. Absolutely. Like any other society, if you have a need, you should voice it and put it down in writing. And maybe if we collected say 10 interests, we can go to AAPMR and just at least let them know this is something that people are interested in. Maybe they already have resources that I can go again and share with you. And if not, then I should let them know that this is something specific. So everyone have it, this is my email. And Joe has been kind enough to actually say she would be a mentor. Oh my goodness, how kind. And I'm sure like there's many people out there who would be happy to take a medical student on. I think in general, as a physiatrist, I really want to encourage other people to go into my field, especially if they have an interest in research. But yeah, if you're a medical student and you think there will be a benefit of having some sort of a class like this or some sort of like just programmed. And if you have friends who might also think the same, why don't they, you just like email me like just saying like, yes, I'm a medical student who'd be interested in that. And then once I collate things, maybe I can go to AAPMR and just say, look, I have like this five emails. Wonder if this is something we can look into. Oh, and Jilson, share her contact too. Thank you, Jil. Thank you. Any other questions, thoughts, comments? I'm sure there's other attendings here. Hi, this is Cesar. How are you? Yeah, so I'm a fellow here in Dallas and just to share my experience with the medical students because I had to do my own legwork to get into research in residency and fellowship. Just the best advice that I could give them, start early in trying to find a research question with everything that you taught us today and just boldly approach a physiatrist that you have in your institution and tell them, this is my idea. This is even write your own protocol in advance. This is what I have. So I'm interested in pursuing this because I have this goal of publishing this as a poster in XYZ conference. For me, it was always the International Society of PM&R. So I always had that goal when I started in my PUI two year and I pursued that goal because I wanted to go to Portugal and present my poster there. So I just work my timeline back from the day that the conference was gonna be back to the time that I had to submit it. So that will help me to do a timeline of, okay, I need to finish the project. By this time, the statistical analysis, by this time, grab all the data by this time. So if you have that timeline and just reach out, boldly reach out to your research department and they will guide you. They've been the nicest people I've ever met. Your librarian as well, just reach out to them, just email them directly and tell them, I need your help in pursuing this bibliography. The research department will guide you into getting access to REDCap and all the certificates with CITI that you need to do. But all that started early. And then once you go in through that wagon of going through the process, because it is a process, my thing that always helped me in residency and now finishing fellowship, I have something that I call Research Wednesday Night. So on Wednesday night after dinner, I give myself two hours on advancing my research project. And you will be surprised if you dedicate just those two hours a week, how much of the paperwork and the bibliography and everything that you need to get in place so you can write a good protocol, present it to an attending, and they can be your mentor. Because at the end of the day, every institution will need to, you need one of their signatures so the IRB process can get started and everything. So just having that stepwise approach early, it will help you a lot. And that's what got me to present my residency poster in Portugal. And now I'm going next week to Australia to present my fellowship project. So really, really recommend it. And I highly recommend ISPRM. It's a lot of fun to meet a lot of people from all over the world doing what you do and what you love and they like research. So those are my two cents, because I kind of heard that and I kind of felt that way in training. But just if you are motivated and self-sufficient a little bit and kind of like do a little bit of the network on your own and just present it in like a gold plate to your attending so they can assist you, that usually works for you to get a mentor that will guide you through things. That's all. Great advice. Any other questions, comments, thoughts, other perspectives? All right, well, it's been a pleasure meeting all of you. If you need anything, I put my email in the chat, especially if you're a medical student and you want to perhaps make a voice to APMR that this is a type of resource you would like to have. I think we can definitely at least share that with APMR. I hope you guys have a wonderful night. If you need anything, feel free to email me.

Patricia Zhang

physiatrist

clinical research

research interests

training stages

resources for research

IRB approval

mentorship

research opportunities