j9.05 to 0.27), whereas the correct value is j18.20 (95% CI, j46.62 to 10.22). Similarly, the original result was that the effect of moderate-intensity shock wave was j6.60 (95% CI, j6.74 to j6.46), whereas the corrected value is j28.10 (95% CI, j69.83 to 10.8). The revised analyses demonstrate no effect of shock wave therapy on overall pain; which is opposite to the authors’ conclusions. Correcting the data in Figure 3 provides different estimates of treatment effect on morning pain, but the original and corrected estimates are both statistically significant. However, statistical significance is not sufficient to endorse a treatment. Whereas originally the estimated effect of treatment was extraordinarily small, j0.77 (95% CI, j1.30 to j0.25), it is now very small, j6.51 (95% CI, j11.49 to j1.53). In either case, the effect, although statistically significant, is so small that it is unlikely to be clinically meaningful to a patient. REFERENCE 1. Dizon JNC, Gonzalez-Suarez C, Zamora MT, et al: Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: A meta-analysis. Am J Phys Med Rehabil 2013;92:606Y20
Daniel Steffens, PhD Candidate Chris G. Maher, PhD Musculoskeletal Division The George Institute for Global Health Sydney, Australia and Sydney Medical School The University of Sydney Sydney, Australia DOI: 10.1097/PHM.0000000000000061
RE: PUBLISH OR PERISH? To the Editor: The recent article in the American Journal of Physical Medicine & Rehabilitation on resident research1 raises many good points about research experience during the years of residency training. Toward the end, the authors suggest the possibility of Beliminating the research project requirement I and refocusing efforts on standardizing the training of physicians to assist them in becoming better consumers of research.[1 In a sense, the reviewers agree and disagree with this statement. At the University of Michigan, they have seen the great value of resident research projects. However, that value has been realized only after developing a formal, collaborative process for teaching research through experience. Approximately 10 yrs ago, the reviewers’ department founded a resident research day in honor of their former chair, Theodore Cole. On Theodore Cole Day, third year residents present their research ideas and, ideally, fourth year residents present their results. However, with very little supporting structure, the day had little value because residents did little to no work on projects and presented loosely constructed project ideas. Many had poor or no mentoring and presented projects that were often highly impractical www.ajpmr.com
(e.g., large randomized controlled trials comparing multiple interventions or studies involving large cohorts of patients not seen in their health system). Not surprisingly, most residents produced nothing in the end. This result, or lack thereof, was discouraging for residents and faculty. Over the years, several changes were made to the program. In its current form, it is a valuable, practical, and focused experience in clinical research for the residents. The program includes the following: 1. Leadership from a physician and research faculty, with each bringing necessary perspective to the process of designing and carrying out a small research project. The matching of clinical and research mentors is facilitated by the codirectors of the program (a psychologist and a physician) who are highly trained in clinical research. 2. A timeline and a guided process for residents to choose mentors and then choose projects. The projects are reviewed by the program leaders to make sure that these are sound and practical for the resident. They serve as the Bfeasibility police[ to ensure that previous failures of overreach are not repeated. 3. Each resident has a clinical mentor and a mentor with expertise in research methodology to make sure that the project is well designed and has a realistic recruitment and an analysis plan. 4. Mentors are encouraged to offer projects to residents that are part of their own research program, if possible. In such cases, residents are still expected to generate a research question and design rather than being handed a project by their mentor. It should ideally be a collaborative process. This also encourages buy-in from mentors. 5. After residents develop their research design, they practice their presentation in front of the research fellows, who critique and assist in improving the research idea. This helps to prepare them for the Theodore Cole Day presentations. 6. The residents then present on Theodore Cole Day in the fall of their postgraduate year 3 in front of the faculty and a guest expert, who is asked to give a lecture about becoming a physiatric researcher. 7. During the next year, the resident works with his/her mentors to implement the project and then repeats the presentation practice and Ted Cole presentation as a postgraduate year 4. Ideally, by that point, the project is close to completion, and publication is strongly encouraged. At the end of the residency, they are expected to complete their project and ideally submit a manuscript for peer review. This plan brings the resident through the stages of research with a hands-on and mentored approach. It also has the advantage of giving clinical faculty members, who have limited time and research training, an opportunity to have a resident and research faculty member partner with them in completing a research project. The research faculty members are highly positive about the opportunity to interact with the residents. A program such as this requires some investment in time and Letters to the Editor
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
459
resources. It also functions best in a strong research milieu. The reviewers agree, however, that without this sort of structure, research requirements are basically Bblack boxes[ for residents and will have little value as part of their training. Although it is not the intention of this program will provide residents with training to become independent physician-scientists, it does give trainees a greater appreciation of the process of research and an improved ability to understand what the literature is trying to tell them to guide their practice. Although the goal of the program is modest and in line with the clinical demands placed on residents, it is still possible that through the commitment of mentors and with the support of the program, the career of the next physiatric scientist may be launched.
460
Letters to the Editor
REFERENCE 1. Gaught AMH, Cleveland CA, Hill JJ III: Publish or perish? Physician research productivity during residency training. Am J Phys Med Rehabil 2013;92:710Y4 Edward A. Hurvitz, MD Claire Z. Kalpakjian, PhD, MS James T. Eckner, MD Sonya R. Miller, MD Mary Catherine Spires, MD Department of Physical Medicine and Rehabilitation University of Michigan Medical Center Ann Arbor, MI DOI:10.1097/PHM.0000000000000064
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 5, May 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Daniel Steffens, PhD Candidate Chris G. Maher, PhD Musculoskeletal Division The George Institute for Global Health Sydney, Australia and Sydney Medical School The University of Sydney Sydney, Australia DOI: 10.1097/PHM.0000000000000061
RE: PUBLISH OR PERISH? To the Editor: The recent article in the American Journal of Physical Medicine & Rehabilitation on resident research1 raises many good points about research experience during the years of residency training. Toward the end, the authors suggest the possibility of Beliminating the research project requirement I and refocusing efforts on standardizing the training of physicians to assist them in becoming better consumers of research.[1 In a sense, the reviewers agree and disagree with this statement. At the University of Michigan, they have seen the great value of resident research projects. However, that value has been realized only after developing a formal, collaborative process for teaching research through experience. Approximately 10 yrs ago, the reviewers’ department founded a resident research day in honor of their former chair, Theodore Cole. On Theodore Cole Day, third year residents present their research ideas and, ideally, fourth year residents present their results. However, with very little supporting structure, the day had little value because residents did little to no work on projects and presented loosely constructed project ideas. Many had poor or no mentoring and presented projects that were often highly impractical www.ajpmr.com
(e.g., large randomized controlled trials comparing multiple interventions or studies involving large cohorts of patients not seen in their health system). Not surprisingly, most residents produced nothing in the end. This result, or lack thereof, was discouraging for residents and faculty. Over the years, several changes were made to the program. In its current form, it is a valuable, practical, and focused experience in clinical research for the residents. The program includes the following: 1. Leadership from a physician and research faculty, with each bringing necessary perspective to the process of designing and carrying out a small research project. The matching of clinical and research mentors is facilitated by the codirectors of the program (a psychologist and a physician) who are highly trained in clinical research. 2. A timeline and a guided process for residents to choose mentors and then choose projects. The projects are reviewed by the program leaders to make sure that these are sound and practical for the resident. They serve as the Bfeasibility police[ to ensure that previous failures of overreach are not repeated. 3. Each resident has a clinical mentor and a mentor with expertise in research methodology to make sure that the project is well designed and has a realistic recruitment and an analysis plan. 4. Mentors are encouraged to offer projects to residents that are part of their own research program, if possible. In such cases, residents are still expected to generate a research question and design rather than being handed a project by their mentor. It should ideally be a collaborative process. This also encourages buy-in from mentors. 5. After residents develop their research design, they practice their presentation in front of the research fellows, who critique and assist in improving the research idea. This helps to prepare them for the Theodore Cole Day presentations. 6. The residents then present on Theodore Cole Day in the fall of their postgraduate year 3 in front of the faculty and a guest expert, who is asked to give a lecture about becoming a physiatric researcher. 7. During the next year, the resident works with his/her mentors to implement the project and then repeats the presentation practice and Ted Cole presentation as a postgraduate year 4. Ideally, by that point, the project is close to completion, and publication is strongly encouraged. At the end of the residency, they are expected to complete their project and ideally submit a manuscript for peer review. This plan brings the resident through the stages of research with a hands-on and mentored approach. It also has the advantage of giving clinical faculty members, who have limited time and research training, an opportunity to have a resident and research faculty member partner with them in completing a research project. The research faculty members are highly positive about the opportunity to interact with the residents. A program such as this requires some investment in time and Letters to the Editor
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
459
resources. It also functions best in a strong research milieu. The reviewers agree, however, that without this sort of structure, research requirements are basically Bblack boxes[ for residents and will have little value as part of their training. Although it is not the intention of this program will provide residents with training to become independent physician-scientists, it does give trainees a greater appreciation of the process of research and an improved ability to understand what the literature is trying to tell them to guide their practice. Although the goal of the program is modest and in line with the clinical demands placed on residents, it is still possible that through the commitment of mentors and with the support of the program, the career of the next physiatric scientist may be launched.
460
Letters to the Editor
REFERENCE 1. Gaught AMH, Cleveland CA, Hill JJ III: Publish or perish? Physician research productivity during residency training. Am J Phys Med Rehabil 2013;92:710Y4 Edward A. Hurvitz, MD Claire Z. Kalpakjian, PhD, MS James T. Eckner, MD Sonya R. Miller, MD Mary Catherine Spires, MD Department of Physical Medicine and Rehabilitation University of Michigan Medical Center Ann Arbor, MI DOI:10.1097/PHM.0000000000000064
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 5, May 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
