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Hi everyone um hopefully, you can see my slides um I don't know if there's a chat function um on this to sort of say that you can all see it um. I've seen that someone perfect okay great um So, it's now five past say I'll kick off, so I'm henry, I was previous past presidente of the uh the university from an orthopedic society, so it's a pleasure to be able to um come back and speak to you um and basically talk about um research in general and also um specifically to trauma and orthopaedics, how to get uh into this as a uh medical student and then also beyond that and why why it's also important um so um first of all a bit about me, um so I went to University of Edinburgh, I indicated in sports science medicine um and that's where my passion for research started uh doing a dissertation now um and as you can see here just on the right hand side, um It's just sort of a map of postgraduate um uh career plans after you graduate, so um you can either get it down the sort of normal in inverted commas foundation year, and then you go into a special training before becoming a consultant, or you can step out and uh do a bit of research on the academic side with whether that's the academic foundation program and then moving on to academic clinical fellowship and from there on doing a phd and being a postdoctoral clinical lecturer ship onto being then um senior lecturer and professorship um and as you go along your training pathway, I'll discuss it more later, and I'm happy to answer questions at the end, you can sort of flit, flit, and flow between the two, um so, just because you do a normal foundation year, you don't necessary that doesn't preclude you from applying for academic clinical fellowship afterwards. Likewise, if you do an academic foundation your program, you decide you don't like academia, then you can switch to the normal training program, um so, I integrated in sports science medicine and I quite enjoyed research um and I was it was advocated to apply for the Academic foundation program. Hopefully, you've all heard of it, but essentially it, it varies scenery to Dean ary, but most of the time you get a four month research block um uh rather than an additional f one job or f two job um most of the time that's to do research, but there's also management, leadership and management, academic foundation program um. There, now called specialized foundation um. There's also a medical education one, so it doesn't have to necessarily be about academia if managements or interested in or education, then there are some that are themed around that um So I did my um specialized foundation program or AFP is when I applied in Oxford um so was there for two years before then applying for an academic clinical fellowship, which I'm currently in some st one in trauma, orthopedics, and that's at the University of Work um so that's typically three years where I get to four month research blocks to then um uh use that time to apply for grants um for a phd, and then I'll take time out of training to complete that phd um so that's a bit little bit of an introduction to academia and what things might look like and I can discuss that more towards the end, um, but I thought it first of all to kick off why why it's important to do research well um As you probably are aware that the good medical practice set up by the g. M. C, the General Medical council um say that we should be practicing evidence based medicine um and in that book they say that in providing clinical care you must provide effective treatments on the best available evidence, so we need to know and be confident that um some of the treatments that we are giving or advocating to patient's that it's based on good scientific evidence, that's not to say that sometimes we have to veer into the darkness, so to speak when the clinical question hasn't been answered by research and we go by clinical judgment, but on the whole, if there is research out, there suggests that one treatment is better than the other, then we should practice that and we should advocate that and explain that to patient's um and it's particularly important for orthopedics. I think orthopedics gets a bit of a bad rep sometimes with someone's been called caveman and um you know human carpentry and things like that um but it is important for orthopedics um so um if any of you have heard of the draft or draft to trial, um but this is a randomized controlled trial that's looking at distal radius fractures and there's two ways um to fix distal radius structures um you can you need to treat it conservatively or surgically um. And that's obviously typically typical questions, so no surgical trials, however, there are sometimes some um distal radius fractures where um no matter how much you try and manipulate the fracture under anesthesia, you can't keep it in a satisfactory position with the cost um in which case we have to go down a surgical route and within certain the surgical route, we either have Kershner wires or KY fixation um such as the one above or um we use a plate and some nails to reduce the fracture and keep it in that position. So the draft trial was to see which one is superior um and um they found that there's no difference um necessarily between the two treatment options, but there are fewer complications amongst the Kershner uh fixation, and so it's advocating that when we can't reduce fractures that kershner wires or KY is is the best route to go down, so that's important because when we consent, patient's for theater, or we make them aware of their management options that we need to explain that there are complications, but that research trials have shown that there's fewer complications with the Kershner wire, which is why we're advocating for that, just so that the patient's can be well informed about their treatment, um as well as you being informed as to what the best uh surgical practices out there and I've uh suggest reading more about that if you wanted to about the draft and drafty trials. So in summary, research is important for us clinicians to know what is the best to offer patient's, but it's also important for the patient's that they know what necessarily they get the best outcome, so whether that's um looking at what's the best rate for union or now malunion, um or um what makes them return to function or two sport quicker, which is sometimes uh important to patient's as well as looking at adverse events such as well, they have an increased chance of blood clot or infection afterwards, so that they can then weigh up the risks and vested the benefits, and so that they can then come to an informed decision um with the information that you've provided, so it's important for both patient's and clinicians together, um So you're probably aware of the so called research triangle of uh from top to bottom of what the best evidence there is or better quality evidence with meta analyses or cockerille reviews at the top and then case series or expert opinions at the bottom, So I'm just going to talk briefly about each of the different ones, but hopefully you already have an idea through med school of and doing um subsets of modules um on uh study design and things like that that you you already know some of the pros and cons, so going from the bottom, I've included some existing literature out there of um to give an example of each but a case series basically just provides um an information on specific patient's and their management doesn't compare anything um It just might just states such as in this example, um osteo malaysia case series of atypical clinical orthopedic presentations that it just provides that information, um So it's very limited and it's usually one cohort from one surgeon you're not comparing to anything but it's just reporting what you found, but it can be helped for something that's unusual or rare, such as in this case series, where they're talking about atypical clinical orthopedic presentations um and so that's the sort of base um um low quality of of research, then, we move on to cross sectional studies, where data is collected at one point in time and that's almost like a survey style um um situation. A lot of these studies kicked off around. Covid talking about disruption in teaching, particularly undergraduates, um just seeing how they're teaching was at that particular time compared to um you know and then they could compare to literature from previously, um So I've include this, this study about um cross sectional study of undergraduate teaching of trauma orthopedics in the uk, and relationship to medical school was an interest in trauma orthopedics as a career, so they just took a cohort of undergraduates at specific time point, asked them to fit in a survey or basically where they went to Medical school whether they were insisting trauma orthopedics as a career and then reported on that um so it's a quite a niche um situation. It's only obviously valid for that one particular time point, and for those particular cohort of patient's or participants that you you enroll so it could change. If you then um looked at it later on in time and then picked a new samples um save compared to 2022 2022. Next up on the list is case control, um so what you have is a population with an outcome and a population without an outcome. So for this example, I've got risk factors or knee osteoarthritis, so we'll have a cohort of patient's with knee osteoarthritis and population without osteoarthritis, um and that might be patient's in a g. P. Practice or patient's um just in the public that we um sample um and then what we do is we see if they're exposed to a factor, so are they smokers yes or no, um are the obese, yes or no and then through um statistical analysis, we can see if there's any association between being a smoker um and developing osteoarthritis compared to the two. Um Obviously, we're working backwards so it can only really be an association rather than a correlation because um we are working backwards rather than it being prospective, I e, that we have a group of patient's that we follow up to see if they then develop near way, which is more what a cohort study is. Hopefully, you can see that a bit better that's um come out quite small on my screen, but with the cohort study, it's exactly what I described you have a group of patient's that you follow up and you see if there um about the outcome of interest depending on their exposure to certain things. Um So this is orthopedic trauma, patient's, and depression. Um So also you get patient's who come in with a major trauma, cool patient's who've been in road traffic accidents, have an operation under orthopedics, such as an introductory now for ephemeral sharp fracture and then we follow them up um save in one month, six months a year and do a depression survey on them and find out if they've had any clinical diagnosis of depression or whether there's any um signs of depression and then we can work out if there is an association between uh going under major trauma and depression and then there's are cts like I explained with the UK draft trial um looking at whether kushner, one of the Ky, ours is better than the plate and fixation um and this is really helpful if you want to know if one management is better than the other um. And then um you can um um because it's a randomized controlled troll you have a random sample of patient's that you randomized to the various different treatment options, and so you can be fairly confident if it's statistically powered um that you can see which intervention is better than the other, and we can amalgamate all the different are cts, into meta analyses or a systematic review, and this combines all research out there on our cts and we then make a forest plot, which is shown on the left hand side, where we can see where there's a control and then an intervention group and we can basically synthesize all the research that's out there um So that's an example of um uh distal femoral fractures patient's have undergone different um uh fixation, so retrograde nail on the left hand side, and just a fixed angle plate um such as the plate on the side of the femur and we're looking at nonunion and malunion, and so we collect all the studies that have collected or reported data on that, So we in this paper chris totally 2005 to patient's in the retrograde nail out of 35 report had non union, and it's the same in two, I was 37 fixed angle which creates this plot here on the, on, the right hand side, and then you put that in for the other studies, and then you get your uh forest plot here and you hopefully have seen a small triangle which either favors one intervention or the other, the wider the triangle means the wider that the confidence intervals are um which means that you don't um the studies are quite heterogeneous, um but if it crosses this line, it basically means that um there's no fabled intervention um so that's quite helpful just uh if there's lots of research studies out there, which say different um different reports on onions and onions. This is quite nice way to synthesize everything um and this is what you normally see in the cochrane review as well. So that's a bit about uh different types of research and there's also audits or quality improvement, which I'm sure some of you have already got involved in as medical students, so you probably really aware of what a clinical that is, but this is definition here is about. We usually have a standard uh standardized treatment. We want to see if uh the current unit that you're working at um fulfills those standards um and if not, then you normally create an intervention and that intervention um uh could be like a poster or some teaching and then you reassess to make sure that your then reaching those standards. Um So this is the audit cycle um and on the right hand side. This is just an example of open no limb fractures in the uk and it was a multi center prospective audit, so it followed up every patient who presented to orthopedic departments with an open fracture um and some of you might have heard of the based guidelines b. O. A. S. T. Guidelines. Um These are the british, orthopaedic association, especially um specialty guidelines um So these are standardized guidelines um that all units should apply to you and there's various different ones from from open fractures to if someone has compartment syndrome how to manage that um and it was just to see if how well um department had heard to those both guidelines um and there's also obviously lab based research, which is important in orthopedics um So um there's this one on the left hand side where the platelet rich plasma um is beneficial in tendon healing and normally that these um studies are based uh at the bench and hopefully then more translates to the bedside, um but often there are a lot of um studies that are done, which I don't quite make it to the bedside, so now I guess knowing a bit more about research and um different types of research why should you get involved well. Um It's quite exciting to be able to add to the evidence base um and to um put your research out there whether it's um even if it's like a case control or a cohort study or an audit, quality improvement to do, it's also quite interesting, it's interesting to be able to answer particular research questions that are unanswered, particularly orthopedics because sometimes there are a lot of things that we do that. Maybe it doesn't have to, didn't traditionally have the best evidence based, but it now has more of the evidence base um and I guess at edinburgh particularly um we're also expected to have some research or at least I was when we're doing students, sector components um such as in your s s c five, where we had an independent research project we could do, but also it's important view portfolios as I explained with the general good good medical practice from the g. M. C. We are expected to research and it does come up when you apply for jobs. Unfortunately, just the way that this um slide is on medal. It hasn't quite worked, but um it's meant to show that at least for st three applications for orthopedics, you can see here um that they ask since starting undergraduate medical school, how many publications have you got and they give you one point per paper um for um presentations that you uh for papers that you've published with a pub med, i. E, and also asked about how many presentations you do um conferences when you get a point per perp, presentation for that, so um research does mean points when it comes to applications which can help and that's the same for when you apply for um call surgical training or for the academic clinical fellowship um. There are points there as well as points for doing full audit cycle of quality improvement project um. That's important and being able to present that national internationally and I can provide a few links at the end. If you want to look at what s scored in the portfolio section of the court surgical training or st three applications because, if you are orthopedic inclined or have especially at least in mind, such as plastics or anything like that, you should look at the Court surgical training portfolio guidelines slash s t three to know what you're working towards. Um you've got almost as much time as you probably will ever have as a medical student to perform research compared to when you're working and working shift patterns, so um the more you sort of prepare now um does help in the future um So you don't have to be constantly working when you're um also at work clinically, so how to get involved. As I mentioned, the student selected components are helpful. Um If you've got a chance to integrate um doing a dissertation and something that's surgically inclined can really help because then you can then move that to being published um and that's what I did um you can also email registrars or consultants um particularly in edinburgh. There are many registrars you do mds or phds and they're often looking for extra pair of hands and it's an easy way um to help out with the project and sometimes you get more than one paper published from that um. And that's what I've also done, I managed to help out a bit uh one of the registrars who's doing an md and I've got two or three publications from that. Um You can also come up with your own project. If you've ever sort of wondered why we're doing this and you you've spotted a gap in the richer and then you can speak to the consultant about it when you're on placement. There are also options to do summer projects. If you wanted to particularly if you're in first or second year and you've got the four month summer holiday, um. I know a lot of consultants would be happily obliged to have um some of the projects, and there is also an opportunity for collaborative research when there's an organization called Star surge, you do a lot of collaborative research um and you just help with data collection um and then you get collaborative authorship, which as a side note is slightly different to being a co author on the paper, um that you want published um and some portfolios don't actually school, collaborative research, but it can be a helpful starting point to getting involved in research, so look up star surge if you're interested in in that um but often they're quite good at advertising to two medicines to help out with with research um So just some tips and tricks for for for me um from my experience um conditions can be very busy um particularly consultants, professors, they get hundreds of emails each day, so if you sent out an email and you've asked that you're interested in orthopedics or plastics or general Surgery and you want to be involved in research, but you haven't got a replied, don't be afraid to be persistent um Within reason, obviously don't if you haven't heard back in a day they email them, but um after a week, then maybe it's it's uh it's probably relevant also you meaning your CV might help just if particularly they don't know so they know a bit more about your background, especially if you're on your um aurthur placements or surgical placements, speaking to the registrar's or consultants to see if they have any projects here your incident, a specialty you want to know what research they might be out there, then they can point you in the right direction or they might have potential projects that they need a hand in, also helpful to speak to the module, lied. I'm not sure who the module lead at the moment is, but it was Jamie Nicholson New, was quite keen on on research and helped me to um help link me to a couple of people that want to do research, and that's also helpful starting point because they need the department as well and then normally quite accessible um. And now just talking about sort of being ristic, what with what your role will be, but also what would be helpful um so being, um collecting data on patient reported outcome measures that's um those are basically questionnaires that are sent out like the Oxford Knee School, which is a list of criteria that sent out to to patient's to fill in and then you get a score about there, level of function with the near example and there's also equivalent for Oxford Shoulder School. There's lots of different problems out there and um a lot, sometimes your job is just creating a database on excel, where you record all these and then it helps with data analysis, so that's quite helpful because then you can explain to uh interviews that you've had experience in database management. Um It's also easy to be involved in a systematic review, so that's like the meth analyses, where you look at all the research that's out there um um And that's also quite helpful because it's quite a simple project, city because it's library based um and you can do it remotely. Um It's also quite quite helpful to do some audits or quality improvements because you have time to collect the data um. And also then um apply an intervention. Um It's quite hard when you're on f one or f t, because you're on four month rotation, so um having the ability to to be in a place for a significant amount of time where you can end develop an intervention and rerecord. Um It's quite hard within those four months, whereas as you're a medical student, your your urine edinburgh, your medical school for at least six years um and once you get towards the end of the project, I suggest saying that do you mind if I help right in the introduction and the introduction of a research project is normally basically just a literature review, reviewing what literature is out there or seeing how much you can you can help with that um. So um there's lots of different things that that you can do, which will be helpful um in a future research career out there, but also just helpful to to have him under under your belt anyway, so the main things that you need to get out of research or aim to get out uh that if you're doing a sort of a clinical outcomes, so seeing what is better than the other or seeing how patient's do after a specific type of operation, um be able to uh collect the data on excel or a database management system is helpful as well as then helping out with statistical analysis of that and then drafting a manuscript. Um If you're doing a systematic review, um you can draft a protocol, which is also quite cheeky way to then get another publication because quite a lot of time people publish their protocol um and also it's important to register that protocol. Um There's various registrations out there, such as Prospero um you can contact librarian as to how to do a proper literature review um and that's also quite helpful to gain experience in that sort of statistical analysis and then the script drift drafting. If you're doing an audit, um it's helpful to know how to roaster an audit with your local trust um and then collect the data in the database management, perform the intervention, and then do a statistical analysis and with all of these projects, it's easy to also present a conference somewhere, so I just um stress that you can easily look at national and international conferences and normally if you're doing research for the registrar, they'd be able to um highlight what um conferences are coming up on what you can apply to but various organizations such as Evote, which is the Europe European Federation for the pedic and trauma um well, the british orthopaedic Association have an annual conference and they also have a medical student section there, um So that's a specific um uh um session in the afternoon where medical students present, um So that's an easy way to get a national presentation or there's also esco, which is a European sports um uh reappearance society for sports, um uh the arthroplasty, uh arthroscopy, sorry um that also has an annual conference and that countless international presence european and then you can also ask after you presented it because normally the process is, is that you do the project you present it and then you work to get it published somewhere, so see, if you can then get it published and most of the time the registrars will be keen for that, um So the um this is just to be aware that there are different tiers for the outputs of your research um say sort of being quite with the mean culture being top to middle to the bottom to so top tier is obviously being first author and that can be helpful if you're doing like your dissertation um as part of being a greater degree and you wanted to work to get that published. Um You can be first author because you basically done all the work and the research for that, and you can also be the lead presenter of all that and that's where you get the most points the most applications to give you more points of your first author was also helpful. This If you're doing a project and you've done joint amount of work with someone else who is first author, you can also request to be a co joint first author um which is also another valid way to get first authorship and more points of your portfolio um. And then there's also a middle tier where you're just a co author um So that's just all the list list of authors on there um or you could be part of the project that was presented by someone else, which does count as a presentation um. So if that does happen, then I'd make sure that you'd email the conference organizers um to ensure um that you get certificate that your that the project was presented at the conference and normally um it's important to keep the e mails of that, so just say the PDF on your computer um and the bottom tier is is sort of collaborative authorship with star surge and various organizations. It is helpful to do that. It's helpful because it's good research to find out what's happening at different units um but quite well at the moment and it's not actually scored in the portfolio, but it's a helpful starting point to research so that's just something to be aware of and just as stated, always keep your copies of any email certificates of publications that you've had um just it helps because you need to provide evidence for when you apply to jobs um that you've actually have presented somewhere and sometimes they accept just your presentation slides. They want to know that they've seen an email from the conference organizers that you have um uh been accepted for presentation and then you need a certificate to say that you have presented there so if research does pique your interest um um as I said you can you can do academia and and research alongside just doing a normal Foundation year program, it's just a bit harder to do that. When you're you know, working sometimes 70 hour weeks and you just want to rest on your on your off days and you're zero days um and even if you do a foundation your program, you can still apply for an academic clinical fellowship um and then after you do your academic little fresh. If you don't have to do a phd either, you can just jump back into normal training, um but if you are interested, I would definitely advocate doing the specialized foundation program. I think um normally makes places. Um you get a four month research block which is quite nice um during fy, which can be intense um so for example for mine, I've worked for three different projects um two of which have been published now. When I'm just waiting on, I also managed to part uh pass Mrcs Party and part B during f one f two because I had the format research books to dedicate time to that, whereas um if I was doing f one f two, then I might have to be revising for that in my own time outside of work. Um I was also able to just work on my portfolio, ready for application for academic clinical Fellowship, so and generally you do get quite nice jobs as part of the academic foundation program um, So I'd recommend applying and I can answer, ask a bit more questions that if you have any more about the specialized vaccination program or academic clinical fellowship, um but also I just want to stress again that just because you you choose one half, doesn't mean that you're stuck on that side. You can always christian cross between the two or do things down down your own um side um or if you're just not interested in you want to just do clinical side that that's completely fine um but just be aware that you do need to have some research under your about for what do you apply just to be quite competitive, so you know you can have a bit more choices to where you apply so last side. I just want to say good luck um It is possible to be um to get on to research. You just need to be sometimes persistent with who you ask um And once you do a few projects, you sort of get used to things and people, then, if you're effective in one project, the people there and ask you okay you've done one in this project, do you want to do this project as well and it's sort of like a snowball effect. If you have any specific questions that you don't really want to ask uh after this, then you can always follow me on twitter hkC sell um and you can always start message me. Um If you have any questions about the SFP or anything like that, um but hopefully you might be able to answer any questions um um no uh so I've got a question about how does the AfP application process work um so um how it works is you have to come to your six year of your final year of medical school um and you apply to the normal, sorry, I keep saying normal, but I'm just doing that too just to discriminate between the specialized foundation program and you applied for the normal foundation program, and your your Medical school helps you with that in terms of doing the s. J t um and things like that, then there's a website called Oriole and if you want to apply for the Academic foundation program most of the time your medical school will give you a presentation on that. At the start of your final year, there's a place called Oriole um and there's a timeline that's released by the Foundation program website as to when that opens and then um uh Hopefully you're aware that the uk um in terms of medical training split up into different sceneries um so Scotland's one beanery Wells is one Deonarine, northern Ireland's one Beanery, and then the rest um England is split up into various different Dean aries um and for a specialist Foundation program, you can only apply to to Dean Aries or at least that's when I last checked last year that's that was the case um So you apply for to daenerys um and some daenerys asked for a white space question, which is just an application system about why you want to do research others about your research experience um and then you get invited to interview um Should you be successful um and then normally the interview is um uh it varies dina rebuy, Dean Ary um and it's quite helpful to speak to someone that you know who is currently an sfp or has done sfp um to know what the interview questions are like um but normally it's like a clinical station, so they ask you um to verbalize how you assess a sick patient to someone who's hypertensive pyrexic, So they basically want you to talk through a native reassessment and what you do and the aim of that was to see that you're going to be a safe f one um and that you're gonna be safe enough, that because you're doing essentially four months less clinical time because of your research block, that you'll be able to be safe um and then there'll be an academic side where they might ask you to critically appraise of paper or to ask you to talk a bit more about your research or ask you research questions from then. Um They'll rank you um the rank you on your how many papers you've got on your portfolio as well as your entity school to then rank all uh everyone from one to however, many people apply and then whoever's top gets there first choice um and so on. Um If you don't get um the Specialist Foundation program, you just automatically into the normal Foundation program um and then you just go on to apply for your uh your your dina, reason, the normal program, um but also you can turn down Specialist Foundation program jobs um to then go into the foundation program so that's how the application process works in a bit of a nutshell. Um. If things weren't clear just again just type on the text, um so finding another question is how do you find conferences to present your work such as audits or posters. Sometimes just speaking to uh registrars or consultants is quite helpful to know what conferences are coming up, but I'd suggest looking at the british orthopaedic Association um They have an annual conference, which has a medical student side, which is what I mentioned um and that's quite helpful because um you'll be assessed as a medical student rather than applying to a conference where they might be academics there like Prost's submitting their research um um um or um the Royal Society of Medicine um They often have various um conferences going on or essay prizes, and things like that that that can be helpful to find conferences or you just type in orthopedic conferences um to google. Um The most common ones are the efforts um e. S. S. K. A. Um orthopedic trauma society, british orthopaedic association um that just googling sometimes just helps as well, Any other questions, I think hopefully, there might be some feedback. I don't know if that's um that's the case, but I'd be grateful if you'd be able to fill out the feedback form. Henry, thanks uh Thanks for talking. I think feedback could be like automatically sent out to um emails so if you could fill that out once it's once it's through, that'd be great cool, I'm happy to hang around for the next couple of minutes, so there's any more questions that come through uh is it worth entering essay prize is um I um I would say that if you can be bothered with it, then yes because um that's another thing that comes under your portfolio score ng is having any national prizes um So points for prizes can also mean where if you get a distinction at your med, school exams or distinction overall your degree, um but National prize can also be a prize for winning best presentation at a National Conference or also an essay prize. Um When you check if it's an essay prize just make sure that you can um that is something that you're interested in um so it doesn't really go to waste it's not a massive slob, and I also just ask if there's a consultant that's um or a registrar that could be free just to review it because sometimes it's helpful just to get a second eye on things and just make sure it's definitely like a valid body that you're applying to you so that you would then get certificate of that. It's a national prize um and the Royal Society of Medicine also has quite um it could link on on different um essay prizes that are out there. So in short, yes, it is worth it if, if it's something that you're interested in um and can dedicate time to because quite a lot of time. Not many people actually apply to these essay prizes um Say, sometimes it can be quite easy to uh to win those any other questions. Uh If not, then you're you're free to else do you enjoy the rest of your evening, um and then you can always put me on twitter or whatever uh did you have any other questions. Yeah there's no other questions we could uh could end it end it there. Thank you very much henry for around there or is it all and all the best skies for your future resets careers or orthopedic careers, cheers henry.