The views expressed during this session are those of individual presenters and participants and do not necessarily reflect the positions of AAPM&R. The Academy is committed to maintaining a respectful, inclusive, and safe environment in accordance with our Code of Conduct and anti-harassment policy available at aapm&r.org. All participants are expected to engage professionally and constructively. This activity is being recorded and it will be made available on the Academy's online learning portal. You'll get an email sent after this activity with a link to bring you to the recording and an evaluation that we request for you to fill out. For the best speaking experience during this activity, please mute your microphone when you're not speaking. To ask a question, please use the raise your hand feature and unmute if you're called upon or use the chat feature to type your question. Thank you all and have a great time. Hi, I'm Patricia. I am a physiatrist at the University of California, San Francisco. And I think we have one more person waiting in the waiting room. OK, thanks. So I'm happy to do this session however people want. Last year, we actually ended up having, I think, 20, maybe even 30 attendants. So then it kind of became more formal. I ended up giving a presentation on some resources to help people get started in research. And then we did a little bit of a meet greet at the end. But right now we only have three attendees. So I don't know how interactive you guys want it to be. I'm happy to say hi or maybe there's only two attendees. I'm happy to just have you guys kind of tell me about yourself and maybe help you brainstorm and doing whatever research you want, where I can easily go through this presentation I have, which is like 10 minutes long. If you want to, you can say hi and tell me about yourself and maybe what in particular about research and physiatry you're interested in. Or I can just go through the presentation as it is going to be recorded and maybe some other people might find it helpful. Hey, how's it going? My name is Alf. I'm a third year medical student from Kansas City. But first, thank you for taking the time to do this presentation. I would I don't know about the other person in here or the other participant, but I'd be happy to hear parts of the presentation and ask questions at the end and have conversation after that. But I'm open to however you want to. Yeah, no, that's fine. I think it's also good. Sorry. It's also good to have that presentation just for the recorded component. Fair. Let's get through it then. So the way I organize the presentation is that everyone who joins the session is coming from different backgrounds. And actually, last year, too, we ended up having quite a few med students and then also even some early on interns or residents, because they want to be involved in research and they weren't really quite sure what tools might be out there for them. And, you know, I think sometimes when you're a student trainee, you feel like there's a need to do research. But once, especially out of training, it's like, do I have to do research? And, you know, I think on training, I think of it as kind of being this big cat fight, right? It's hard to get through med school. And honestly, it's even hard to get through internship and residency. So you can get the fellowship and the job you want. And sometimes I think by the time you make it out of training, it's like a sign of relief. And it's you almost want to just like, can I just take it easy and just do patient care and go home? But a certain subset of the population, you know, really feels a calling to do something more than just clinical care, that they feel a calling to do research. And that's a group where I think you do feel an urge to engage and design your own research project and figure out, like, how do I get this to IRB? Like, how do I find money so that I can get the research done? Like, after I do my research, how can I disseminate my research so I can do more research or at least tell people what I found? And so this is kind of a really broad presentation, but just give me some background about how to design a research question. And then we're going to talk about some resources that might be available, both for those people who, like med students, are in a medical center setting and then also people who are perhaps not med students anymore and maybe in private practice. Like, what resources are there for even people who are not in academics anymore? So you can stop me anytime if it's at all helpful. I think when you first think about doing research, you really have to think about what is it that you're going to research in? And there are certain frameworks to think about this. So first, of course, you have to start with a topic. So just kind of walking you through this process, let's just say you were lying on the grass and you looked at your cat and your cat is leaping and trying to catch a butterfly. And you're like, wow, do we know how the cat manages to jump so much? Well, the first thing you should do as you're thinking about a research question is I really encourage you to just do some research about whether someone else has studied this. I'm kind of made up of like a really crazy example. Obviously, most physiatrists would not be doing research like this. But if you are wondering how far can a cat jump, you should go to your favorite way of looking at existing research, like sometimes Google Scholar or PubMed and do some work on trying to understand what's already being done. Once you have a better understanding of what is available in the preliminary research, then you should try to narrow down your topic and determine like a specific question. And there's many frameworks about how to think about this, but I think one of the most easiest one is something called finer, if you ever thought about it. So, you know, a good question, a good research question could be should be feasible, interesting, novel, ethical and relevant. Right. So, you know, if you were going to like have a question about like what is the cat thinking about while they're jumping? That's may not always be feasible because we it's not really easy to understand what is a cat thinking about because we don't speak cat language. It should be interesting where else you wouldn't be engaged in. It should be novel. And that's why you did your preliminary research. You don't want to be repeating something that someone has already navigated through and have already found out about. It should be ethical, right? Like you might be like, wow, if the cat closed one eye, then maybe it cannot jump as far. But, you know, like maybe you can put a patch over the cat's eye. But you have to think about ethically, like, would that be OK for you to do so? Like you don't want to be harming the cat while doing this. And also it should be relevant. And I would say in general, this entire line of research may not be extremely relevant. I mean, if you look at what's published, if you look up cat jumping distance, you see there's like one hundred ninety two thousand results that I was able to find on Google Scholar and low back pain, for example. You could find four million six hundred thousand results. And I think just as humans knowing more about how to manage, diagnose, treat low back pain, that be a little bit more relevant than trying to understand how cats jump so much. So, you know, there's many different types of research. I think some people would broadly separate this into quantitative research and qualitative research. So quantitative research is more about like our adopted children who have parents with elevated BMI compared to those parents with normal BMI at an increased risk of obesity. So it's more numbers based. And one way of thinking about that is you really think about the population, the intervention, the comparison. So here it's the parents with elevated BMI compared to those parents with normal BMI. And there's some sort of outcome. Qualitative research, I usually think about like focus groups or something like that. Like so things like attitudes of health professionals towards caring for older patients with dementia in acute setting. And you think more about just population exposure and outcome, not so much usually about intervention and that type of comparison. There's a lot of resources to help us get started with research. So, for example, like an academic site like University of California, San Francisco, where I work. Often if you are interested in research and I would encourage medical students who's part of this to just go online and see what's available at your school. Even as a medical student, often if you have the interest and reach out to certain basically like we have like the center of research, you can explain to them like this is where I'm at and they can tell you what free resources there can be. But at UCSF, we have literally various organizations that help with pre-studies and with regulatory for like, say, clinical trials or FDA type of activities. And then also just a lot of support for managing of studies, including resources where you can store your data safely and also training on good clinical practice. So here we have actually a center that's just Clinical and Translational Science Institute, and you can book some time with them. It does cost us about $125 an hour, but often the first hour is free. But, you know, at your academic site, they might help with study design and implementation. Mostly they're very helpful for biostatistics because you and I may not have all the resources to run the statistical analysis we need. So sometimes once you have a good plan and you've collected data, you can hire an hour of analyst time and hopefully they can get the results for you so that you can then go on to publishing it. One big issue about any sort of clinical research is that we do want to do whatever we can to keep it safe and ethical for the research participants. So you have to do something called IRB. Here it's easy because at academic centers there's already IRB institutions and often it's a free resource. It is a little bit harder for private practice. I would say if you're in private practice, sometimes you don't have access to all the resources I just mentioned. I would encourage you to go online. APMR actually has a pretty good website on getting started with research. It's helpful for residents. They kind of really try to make the process a little bit protocolized. So guiding a resident to thinking about research. They also have a website on grant opportunities, how to try to get medical research funding, how to write a grant funding, and then also some simple things about like how to perform a PET-MET search and statistical computation and selecting statistical tests. Another good resource is Association of Academic Physiatrists. They even have for medical students rehabilitation research experience for medical students. There's also another one for I think residents who are more interested in research, but I definitely encourage medical students who are hearing this as a recording to look into this if you're interested in. But getting back to the fact that IRB can sometimes be difficult if you're no longer in an academic institution, there are external IRBs. So we have actually our institution sometimes used WCG. The issue with this is that it can be quite expensive and to get an IRB approved sometimes it does take thousands of dollars. And I do think that unfortunately that is a big barrier for doing research, clinical research in private practice is that if you don't have external funding to fund you and you're going to have to pay out of pocket for these external IRBs, it can be somewhat cumbersome. And that's why we sometimes talk about where do we get the money? If you're in an academic center and sometimes there's department funding for research like there is here in my department. Sometimes I have seen private practice groups, you know, getting your name out in research, getting to present at societies, it can be a good way of publicizing your clinics. So sometimes even private clinics just decide to pull some money together and do some research. They also sometimes more engaged in kind of privately industry funded research. And that is another way of getting money. Foundation of PM&R, I have a couple of slides that they actually sent me. They want to broadcast that they do provide some small funding, $10,000 to $30,000 for projects. And then other societies can definitely provide funding. I'm a spine specialist, so I often work with these organizations. But there's brain injury associations, there's different associations for spinal cord injuries. And I didn't have a chance to add in. There's, of course, like also pediatric specific societies and they offer their own fundings. And, you know, if you have a really large project, a multi-institutional trial, then often those are funded by NIH grants or PCORI grants. Just going to take a quick moment, like really breathe through some of the slides that the Foundation of PM&R has sent me. They really are here to support physiatrists through research and they offer quite a few funding mechanisms. But they want me to highlight that they've given out $2.5 million in pilot funding since 2002. And, you know, I think this is a great opportunity for medical students and for residents. I was really fortunate to have gotten such an opportunity when I was a resident as well. And that really helped to solidify my research interest. And once you're funded once, it tends to make it easier for you to go on to secure additional funding as they're also advertising here. And so it's a great first step. And I encourage you to look at their website, which is going to be right here. And they actually did also, this will be published online later, but you can always contact Phyllis Anderson if you want to specifically talk to someone about it. So kind of going on with the rest of my presentation, if you are no longer a medical student and you're attending somewhere, then sometimes another good way of finding help to further a research question you have and also to further a career is actually to work with students. I've had pre-medical students engage in research. I've worked with medical students. And of course, because I'm an academic center, we have residents and sometimes fellows rotating to us. Sometimes, you know, I do encourage attendings who haven't had a lot of experience working with students to really think of this as like a whole endeavor. You know, often pre-medical students and medical students need some guidance when you're first starting out on research. So I don't want you to think like you have an idea and you just give it to the medical student and hope the medical student is going to come up with the finished product. It's almost like you have this kind of meet weekly with the students to make sure that he or she is on the same page and also really map out what needs to be done on the research and give clear instructions. Because, you know, often it's a two way road. The students hopefully are able to help you in finishing the research, but hopefully you're also guiding in the students and helping them understand how to engage in research. And so through this process, research is done, but often you would need to provide some guidance. The other question that we often have is, you know, does your quality improvement project function as research? Many of the physiatrists here, you're probably like going through continued like renewal for kind of our license requirements. We had to do continued medical education. And so that includes often doing a quality improvement project. And often quality improvement consists somewhat of research. And so I've had some discussions with the IRB here at UCSF about like if this was a QI project and do I need to go through IRB? And actually, our IRB office says that it's not always needed. Like if you did a quality improvement project and that is just like how did I improve triaging for my clinic? And you found something that was really helpful. You have this algorithm for low back pain patients, this kind of triage who needs to go to surgeons and this is how you need to see a physiatrist. And these are people who might just go directly to physical therapy. If somehow as part of your QI project, you really found like your particular algorithm was able to increase patient satisfaction, then our IRB actually say that you don't technically need IRB to publish this research. Now, one caveat of this is that often when you're submitting something to a journal, if it has anything to do with patients, the journal itself may require you to have an IRB or have an IRB exemption. So you have to still go through the IRB process. But sometimes, you know, it's not something that you absolutely need to get before you engage in the research, because you actually did this as part of a quality improvement project. So, you know, I put this picture up because I had tried to Google what was the ugliest looking cat. And I mean, this cat could be gorgeous to some people, but apparently this type of cat, which are known as Canadian hairless cats, are known to be a particularly ugly breed. And they were actually created in the 1960s through a natural genetic mutation that just made them basically hairless. And so if you saw a cat like this and you were like, I must let other people know about this cat with this natural genetic mutation. If you have some patient that had a very interesting presentation of some really odd disease, then that, of course, can also be presented as a type of research. You can publish that as a case study or a case report. And so often, you know, different journals have guidelines on this, but that is also some really easy way of engaging in research. If you have a case series of particular patients that are pretty rare, but you've amassed that over your decades of experience, then do look to opportunities of sharing your clinical knowledge, because that might prompt other people to look into these rare conditions more. And, of course, you know, looking at where you can disseminate your research, AAPMAR, AAP, ACRM are great conferences to present your research as abstracts. And there's a variety of different journals, the Purple Journal, the Red Journal, the Annals of PM&R, and, of course, a lot of kind of subspecialty specific journals. So really quick presentation. This is pretty much my last slide. You know, I always I'm very excited when people express interest in research. I think in our field, there's so much we have to learn and we're not going to be able to learn them if people don't engage in research. So hopefully you guys feel the call to do more research. I'm happy to kind of open it up. And if anyone wanted to kind of discuss their particular interest, I'm really glad that Pratish had kind of put in the chat some kind of specific research project that Pratish might be interested in. So TBI use of glucose immediately after trauma and tendons and healing, anything MSK, stroke, the use of strength training, CMS recovery. Yeah, I mean, all these are very interesting research projects. I think sometimes it's really good to just look at what clinic you have access to. So I'm guessing you, Pratish, you're in inpatient rehab. Is that what IPR mean? So I'm not sure if that's what it means. Like, you know, like for me, if I do back pain research, it's very easy because I literally this is clinic is for back pain patients. It would be a lot harder for me to like all of a sudden look at stroke and strength training and if there's anything. Ah, I see. So, yeah, I think the first thing to think about as a med student or whatnot, if you're interested in research is, is there someone to support you in research? If you're attending and you're already out in practice, I think it's what mentors might be available. And then specifically what research, what patient population you have access to. Right. So if you're in inpatient rehab, then I'm not sure if you're seeing a lot of tendonitis in inpatient rehab. But if you are on a ward where there's a lot of stroke patients, then you could even talk to the physical therapist there and be like, you know, are there certain patients who would be good candidates for strength training? And if the physical therapist is open to that, then, you know, can we start a pilot program where the people who are good candidates, you know, as part of the PT, they're just already going to be incorporating some strength training. And then you could even kind of randomize somehow, like, like this group would have strength training and this group wouldn't. And then you can have even some just a survey, like how satisfied patients were with a physical therapy. Or you could also do something objective, like have the physical therapist measure strength and see if the stroke population after strength training, do they have better CNS recovery? I think the important thing here is to think about, especially once you're out of training and you're not an academic site, what is the easiest way of doing research without having to incur a lot of added funding needs or added time needs? So often it's something that could be incorporated, already paid for as part of services. Maybe they're going to brainstorm other thoughts. Look at more cat pictures together. I always last time I had provided my email to everyone in case that will be helpful. But happy to open this up and just meet who's here and talk about your research interests. Hello. Hi. Hi. My name is Hayden. I have a simpler approach to research. I want to preface it by saying, I've done research as a PhD, and as an NIH postdoctorate. After a residency, I took a job at in the inpatient rehabilitation facility, where there was no real support for research. It was not something that we were expected to do. The focus was on making sure that you earn the dollar. So, along the line because of my research background. I was curious as to whether or not I was optimally performing a procedure. And so I recorded data, patient, age, gender, and I happen to have been doing injections for spasticity. I started with botulinum toxins in the mid 90s. I found that the patients needed injections. Every three to four months. I got so busy that I could not deal with the patient load. And as a result, I had seen as a resident, somebody doing phenol nerve blocks. So, I started to do lidocaine injections. And once I got my technique down. I started to do phenol nerve blocks. And I recorded data for every patient musculocutaneous nerves. Opterator nerves, tibial nerve at the popliteal fossa. And the past three years, I presented my data at AAPMNR, the conferences. So, essentially, I analyzed my data. Sometimes using qualitative techniques. For the modified Ashworth scale, I used qualitative data. It's an ordinal scale. And with that, you use a Wilcoxon rank sum. And came up with interesting data that I presented. My point is that as physicians, we should ask ourselves. We must ask ourselves. Is our performance optimal? If we're doing a procedure, record data for that procedure. And over time, you'll have enough data to look at and say, boy, I've got a great outcome here. Or this is not a good outcome. I need to change my approach. So, I'm saying that everyone should be doing some sort of an assessment of their performance. To determine if it's optimal for their patients. So, part of the problem is that physicians are not trained in statistics. So, we don't really have an understanding of how to go about analyzing the data. And I think we need especially those in an outpatient practice. Or an independent practice. Not a hospital or an academic setting where we have support systems with a statistician. So, it would be great if AAPM&R provided us with some guidance about how to go about analyzing data. That being said, as a reviewer for abstracts, I reviewed 39 studies. Or 39 abstracts that were submitted by AAPM&R 2025. And of those, 24 were given to me with data that was statistically analyzed. Unfortunately, they often use the wrong statistics. For example, for the modified Ashworth scale, the data should be presented as median with the interquartile reported. Instead, they were reporting mean and standard deviation. This is an ordinal scale. And must be reported with statistical tests that are descriptive. Not quantitative. So, this is an example of how many physicians had a desire to do some type of research. But used the wrong statistics. How do we go about educating the rehab doctors about appropriate statistics? That's just part of the whole scheme. Finished. Thank you for those thoughts. And really, thank you for taking the initiative to do your own research and sharing them at AAPM&R. I do want to highlight some of the resources I had mentioned in the presentation. If you go on the AAPM&R website, I really found this to be helpful for students who are really starting off. Research guidance and funding opportunities. The resident research packet is more of kind of how to find a mentor. Like choosing a topic like what we discussed. There's some funding resources as well. And I think, you know, Dr. Alfaro had been kind of touching upon study design and statistics. These are really rough, honestly. I think it's hard to replicate a Ph.D. through some sort of, you know, like they're talking about ordinal skills, which you had just talked about. And I don't have a great answer. I mean, I don't think you can replicate a Ph.D. or statistical course by just necessarily reading these guidelines. But I think at least the resources are there that might help you kind of consider these things. And then, as I kind of mentioned before, they had a little bit of a component of statistical computations as well. So it's just basically referring you to another website. I encourage you to look at these resources on the AAPM&R website if you're interested in that. But I think everyone should take guidance from Dr. Alfaro. I think because he has the willpower to engage in this, he was able to track the outcomes of his own injection. Well, he was able to track the outcomes of the patients that he was able to inject. Did you end up doing an IRB before you started tracking? Or did you start this as a QI project and then just decide to publish it? No, there was no IRB. I didn't need approval from anybody. Just as we do, those of us who do injections, maybe joint injections, nerve blocks. So that's what I was doing, primarily nerve blocks. And I just started recording the data to see if there was some consistency. So no need for an IRB. No need for funding because I was performing this on the job. This was part of my work. And I just started to continue to record the data. Does that make sense? Did you publish this in a journal yet? Pardon? Did you submit your results to a journal yet? I'm preparing the first one for stroke. Okay. Yeah. Sometimes I found now that the journals are very adamant that you have to either supply an IRB that's being approved before you submit any patient data, or they would ask for proof of an IRB exemption. Like you submitted this to IRB and they deemed it exempt from an IRB. I don't know if you're going to run into those issues. But I do agree that a lot of quality improvement projects, which this almost sounds like it's part of, can start off with a quality improvement project and then eventually be published so that you can inform others as part of research. I'm happy to stay on and talk more if anyone has individual situations where I could be of help and maybe talk through what might be available. I'm happy to do that anytime. Chris was there anything you want to do before we wrap this up? I have another question. Oh yes. All right. So the past three years I submitted and it was presented at AAPMNR. So I want to know whether or not I can get for those projects approval to fulfill my requirement for the PIP. So I asked AAPMNR, one of the workers at the main office, and he said that my projects dealt with neurological changes as a result of phenol nerve blocks and that the American Board for PMNR was not accepting that neurological research. Do you or anybody know anything about this? Happy to have other people chime in. I do not know. I don't know why this wouldn't be consistent with a PIP project. So did you ask the American Board of PMNR this? Because that's what you're trying to get the credit for the PIP project, right? Yeah, I have to go that route. Yeah, you should probably ask the American Board of PMNR. I think what might be the issue, and I'm just totally giving you my opinion here, which could totally be wrong because I'm not part of AAPMNR, is that it's not like the AAPMNR would take your abstracts that have been presented and just give you credit for them. You're still going to have to go through their like protocol of submitting what it is that you did in order for them to review it. So you have to put it on their portal. I don't know if that's where the issue is. But I did my PIP on like something just in back pain clinic. So I don't see why you can't do it in your field, which would be more kind of stroke or kind of neuro rehab, spasticity management. Agree. I support you. So I will reach out to AAPMNR. Anyone else have any thoughts? We're just opening this up to questions about how we can maybe support each other in research. If anyone has any questions, feel free to throw that out or I will ask Chris if there's anything we need to do before we wrap up. Alright, well thank you for joining our session. I'm sure my email is also going to be up in the link and you can email me if I can be of any service. Hopefully all of you guys go on and continue to do amazing research. Thank you for being involved in research.

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