Enhance Your Practice Podcast

EP 83: Clinical Research in Plastic Surgery Residency

• ASPS University

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Explore how residents balance the operating room with clinical research. This episode covers why research matters, how to start, and how it enhances evidence-based practice.

Host: Aleksandar Jovanović, MD (Serbia)

Guests:

Lynn Jeffers, MD, MBA, FACS

Justin M. Sacks MD MBA FACS

Helen Xun, MD


SPEAKER_00

Hello and welcome to the ASPS International Residence Forum podcast. I'm Dr. Oksandr Ivanovic, surgery resident at the University of Berge, Serbia, and on today's episode we will be diving into a topic that sits at the intersection of surgical training, academic growth, and innovation. It's clinical research in plastic surgery residency. Research in plastic surgery has evolved dramatically over the past two decades. As publication expectations rise, so too does the pressure to balance research with a demanding surgical schedule. On to those today's episode, we are lucky to be joined by the past ASPS president, Dr. Wynn Jeffers, Dr. Justin Sachs, and Dr. Helen Schank to talk about clinical research in plastic surgery residency. I'll turn the mic over to let the Professor Jeffers introduce themselves.

SPEAKER_01

Great, thank you. Thank you for having me today. I'm Lynn Jeffers. I'm a past president of the American Society of Plastic Surgeons. I am a uh plastic surgeon in private practice out here in California.

SPEAKER_00

Thank you, Dr. Jeff. I'm Jeffers. And please, uh I'm gonna please Dr. Justin Sachs to introduce himself.

SPEAKER_04

Hey, great. Thank you so much for having me. My name is uh Justin Sachs, and I'm the chief of the division of plastic and reconstructive surgery at WashU in uh St. Louis, Missouri. I'm also the um vice president, finance, and treasure of finance and treasury of ASPS.

SPEAKER_00

Thank you, Dr. Sachs, uh, for being with us. And finally, I'm gonna ask uh Dr. Shun to introduce herself, please.

SPEAKER_03

Hi, thank you so much for having me on the show today. I am um Helen Shun. I am currently a PGY5 integrated uh plastic surgery resident at the Beth Israel Deaconess Program for Harvard Medical School. Um I have been researching um on clinical outcomes and modifiable risk factors and happy to talk about it today.

Why Research Matters In Residency

SPEAKER_00

Thank you so much, Dr. Shant, for being today with us. Uh I would like to start this uh important topic for us residents with a big picture. What do you think the clinical research matters during the plastic surgery training? And what is the role uh that you think that is uh it plays in sharpening uh abort skilled residents? Please, Dr. Jefferson, can you start? If you like.

SPEAKER_01

Yeah, I I I think it's important to do um research um throughout the time. Of course, you've got people on this podcast that are a bit biased because we're all involved in research in one way or another. I got involved in undergrad, but to me, it's part of that scientific process and really trying to um bring the specialty forward and to advance knowledge and advance our techniques. So to me, uh I love being a part of that. Also, it really encourages critical thinking, innovative thinking, as well as just understanding how uh, so so to speak, the sausage is made so that you can critically evaluate the literature that comes out there. So for me, I believe that it's an important part of understanding plastic surgery, um, whether you do that for your entire career or not.

SPEAKER_00

Thank you, Karmar.

Building A Clinical Research Engine

SPEAKER_04

Yeah, that's great, Dr. Jeffers. So Dr. Sachs here, um doing research during your residency or your fellowship, or as a faculty member. So at WashU, we have uh 24 residents and research fellows, and we have uh clinical research support staff that exists within the within the division. So it's really important to uh that we have a clinical research engine. And I think for individually as a resident doing uh doing research during their uh their training period or as a gap year or um you know in in other other time frames, maybe on electives or on vacations, it really what it does is it really helps you develop um critical thinking about what we do. So I always say I'm a surgeon scientist. I think that uh you know Dr. Jeffers is a surgeon scientist and Dr. Shun is a surgeon scientist, so it really helps us develop our you know critical thinking and rigor as we look at things. I also think that doing research, asking questions and looking at um uh outcomes improves patient outcomes because if you uh analyze a situation where you do a surgical procedure and you find that one surgical procedure is better than the other or a certain technique helps, I think you can improve patient outcomes by doing research. I as Dr. Jeffers mentioned, I think it advances the field. So plastic surgery is a is a beautiful grand specialty that I think um you know the more research that we do, be it clinical or basic science or translational research, I think what a what by us publishing work in peer-reviewed journals by us standing on the podium or showing off posters or discussing things on podcasts, it really advances the field of plastic survey, which is, you know, I always say is is a head-to-toe uh cancer, trauma, and cosmetic specialty. And we we we work with all the specialty, so it really advances our field. And also as a resident, um, I think it's important that you advance your career. So you're all gonna go out and uh when you're done with residency and you're gonna look for jobs as faculty members, either um on your own in private practice or with a hospital or with an academic unit, and I and I think it allows you to really advance your career. Uh a published paper, uh, a podium presentation, these are the tokens or the currency of the realm for academic advancement. And so without that, um you you don't you can't advance your career from assistant to associate, full professor, leadership opportunities, and also I think finally um doing research uh really fosters kind of just curiosity and uh you know and kind of lifelong learning with all of us. So I think I think you have to question what you do, and then you have to write about it and publish it.

SPEAKER_00

Thank you so much. Uh can I also ask uh Dr. Shan if she has something to add to this?

SPEAKER_03

Yeah, definitely. Uh I definitely want to echo Dr. Sachs and Dr. Jeffers' sentiment here. I think as a surgical resident, it provides another dimension of education. So it really helps balance the day-to-day clinical duties and engages your curiosity, like Dr. Sachs had mentioned. And then also it just diversifies your education. So the community involvement and just widening your network has been really a really big value with clinical research during residency. Um, so not just working with the faculty and getting to know them better, but also outside of your institute, um, and then at national and international levels at uh at conferences too.

SPEAKER_00

Thank you so much. I also think that uh it also helps a lot in the learning process and like uh uh diving into the topic that we are studying and like learning all day and having opportunity to work with different uh different patients, different stories of patients and different diseases, it really helps that. Uh as I can um as I can uh when we see your biography, you started your residency really time ago, and you have a lot of experience and you uh achieved a lot of results during your young career. So, my question would be for you uh how do you think it's changed when you uh see yourself like when you started, and now we're happy to have a lot of uh new technologies, uh data sources, everything is really um there for us that we can find really quickly. Can you just uh describe for us younger residents uh how it was when you started your research career?

SPEAKER_04

Do you remember that far back?

SPEAKER_01

Oh my gosh, I were gonna sound so old.

Then Vs Now: Tech And AI Shift

SPEAKER_04

You go you go first and then I'll go.

SPEAKER_01

Okay, so when I started, um there wasn't the internet. So, first of all, so you had to um do you had to do searches and they would come out on a printout, and then you would go find the sources themselves. Then I remember that um once we you know had our results, and if we were going to be presenting, we would have to take what we were called the slides, we'd have to go to a specific place in the hospital, and they would make these blue slides, uh these slides with blue backgrounds and yellow or white writing, and uh you couldn't change it after that. And they came in these little slides, and then you'd have to put them in a carousel and take that to your talk. Um, and then if you drop them, heaven forbid, then things would be upside down and so forth. So now I'm really dating myself. But uh the fundamental parts about research, the curiosity and the thinking about that, I don't think that has changed. It's just that the number of resources you can have and the way how quickly you can get your background data is out there, and how quickly you can collaborate with people across the country so easily with Zoom, um, with um emails, with um co-working, it's it that part has really accelerated. And I think that's the exciting part of it.

SPEAKER_04

And uh I'll uh I'll continue that. So Dr. Jefferson and I both trained in the same time, probably back in the 90s. And you know, just to agree with the PowerPoint presentations, we had I had to I trained in New York City, Manhattan. I had to go get the slides developed at um 47th Street Photo. I would have to take the film and then get them developed. So there was no editing them but to the last minute, so that kind of dates us. There was no internet uh back then, there was no email, there was no texting. Um, you know, if you wanted to do research, you had to go to the library. I was at I trained at Mount Sinai Hospital in New York City, and I used to have to go to the Gustave L. Levy Library and go up and and and find uh the primary research myself after using, you know, in the in the index cards and the delay cards and finding the the primary sources. So we didn't have all that research at our fingertips to find the data. But I'll tell you what, what we had back then was the same questions. So the same questions were asked back then that they're being asked now. And so the idea of you and your residency program now, you have the great research is defined by great questions. So you have to define a great question and then do the research. The beauty of now, today, and the ability to access all the world's knowledge in literally 60 seconds using large language learning models such as ChatGPT or CLOT or GROC or what have you. It's an amazing thing, I think, for people who are doing research. But it just goes back to the the questions have to be good and you need good questions. But the technology has changed immensely. I finished training in 2000, residency training in 2004, and then did research and fellowships after that. But I started in 98, finished 2004, and the research now is just so much more robust and rigorous because you can access the information so much quicker, and you can use these LLMs to help even refine some of the questions that you have. But you still have to understand what you're asking, and you still have to understand what the information is telling you. So there's a lot, there's still a lot of noise, and the the key is refining that signal. But definitely, if you're doing research now, like in 2025 versus as a res in 1998, you are you can be supercharged, and you really can take advantage of the technologies that exist.

SPEAKER_01

In a way though, don't you think it's a little bit harder now to sift through some of the not so great science because there's a lot more noise out there?

SPEAKER_04

Yeah, I mean it's it's it's hard, but the but but the thing is there's so much access to so many primary resources, and what's beautiful about it is you actually have access to all the world's knowledge. So you're not just looking at one country's knowledge or one specialties, you're literally cross-referencing so many things. So the ability to do profound clinical research now at your fingertips, you know, after an operation is really significant. So you could you you have to take advantage of this technology now, and you can do it much easier and faster. Like I don't have I don't have to take time to go to the library to find sources, I don't have to get the sources, I don't have to photocopy the sources. The sources all exist literally on my phone or my tablet or my computer instantaneously. I think you know, I'd love to hear what what Dr. Sean has to has to say because you know she's definitely you're Helen, you're a baby of the of the internet of AI. So let's hear what you have to say about this.

SPEAKER_03

Yeah, um, yeah, no, I definitely echo those sentiments as well. Um I am only five years out from graduation, um, but what I have noticed uh the big changes is what Dr. Sachs has mentioned, um the emergence of more artificial intelligence, the chatbots, writing assistants, um, more refined search engines, and the large multi-institutional databases that are available now more readily, like Trinetics. Um, but the fundamental methodologies are all still intact, and and it has been kind of hard to filter through all the new information. Um, and I do feel like a lot of the um approaches and methods are still being clarified with the new technologies. So I I feel like I do spend a lot more time just talking to emerging experts in these areas to figure out the best way to translate um the methods with these new technologies.

SPEAKER_01

Sounds like a great one that Dr. Shun can tell us what she does now, because she does a lot.

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Dr.

SPEAKER_03

Jeffers. Um, yeah, so I feel like I'm pretty lucky. I'm at a training program where uh research by residents is really supported by the program and the faculty and is encouraged. Um and so when I first started residency, I knew that uh research was uh was and will continue to be a big part of my career. And so as far as priorities go, it came secondary only to my clinical training. So based on my list of priorities, I would actually allocate specific times during the week specifically for research. And we're really lucky we have post-call days, and so usually my post-call days are my research time, and then Friday evenings are my research time. Um, that being said though, I do think one of the biggest challenges is just with a really erratic and unexpected schedule, just trying to make meetings, and um and I think just being really open to communicating that uh with the team that sometimes you might be a little bit late, or sometimes you might have to reschedule the meetings. Um, usually teams are pretty good at understanding that.

SPEAKER_04

So I'll I'll take the the next um part of this. And you know, we have we have dedicated um ability to let residents take uh a year off if they want during their training program here. Um people take uh dedicated clinical research years or basic science years. Um residents during our training program, they're all required to have a clinical research project that they present at the end of the end of the year. We have our James Barrett Brown Research Day where we invite a busy professor, and it's a big division-wide symposium. So they have to have a project that they present on a podium. So that's kind of baked into their process. Um, we also have during the week uh something called genius time. So on Wednesdays is our academic uh conference day. So starting at 6:30 a.m., we have a hand-faced drama conference, seven to eight grant rounds, eight to nine core curriculum. But from nine to eleven thirty for two and a half hours every week, there's no clinical responsibility for the residents. So that allows um many residents to do you know research during that time or or catch up or ask questions and meet with faculty or actually do the work. So we kind of have it baked into the program where we f we really you know kind of suggest you do some type of research and research project. But if you don't have that set up in your program where the program is supportive of that, where they don't have an end-year capstone presentation of a project or they don't set aside time for you during the week, it can be very difficult. And so then then it becomes you know, what do you do in the week at night and then the weekends? And you know, some will um you knock me, but I think there's you know seven days in the week for work, and there's 24 hours in the day. And you know, sleep is important, but I think if you're committed and passionate to your work, uh, you know, you can spend an hour or two a day uh doing this. And you know, an hour a day times uh you know seven days times seven months gives you you know a lot of hours. And and so I think you you can do this if you chip away at it. But it's really important that you're in a program that supports it. And just to go historical on this, Helen Shun actually, I mean she was a Hopkins medical student and I was there as a faculty member, she spent a year uh working in our lab with me specifically on many research projects. So she took a dedicated year. And if you PubMed uh Helen Shun and Justin Sachs, we uh uh I think 13 or 14 papers that that we published um you know out of that time together.

SPEAKER_03

So sometimes you have to take dedicated time to separate yourself to do that, and also you have yeah, it was like a genius year instead of a genius hour.

SPEAKER_01

I think you went to a really important part, which is being intentional, just like you would with any other priority. If if research was really important to you, you would make that time as you would for any other uh priority for yourself. But it doesn't mean you have to take a year off. You can still fit in research, it's just harder to, in which case it becomes even more important that you find a place if if research is very important to you, that you find a place that supports that. So I would say that for any of your goals, whether it's research or something else, that uh you find an organization ultimately when you're done or during residency that would support the things that you find most important.

SPEAKER_00

Thank you. Is there anything that Dr. Jefferson would like to add to this?

SPEAKER_01

Oh, that was uh that was me, but um I would also I would also add that and you know we could probably talk about this, but I would also add that during your residency, there's probably certain types of research that would be more amenable to a residency program, like ones that don't involve as much timed, you know, that are time sensitive, for example, or have very really firm data points and so forth, so that you can have some flexibility in your um when you work on your research.

SPEAKER_00

Thank you for your answers. Uh my next question would be: what type of research projects and the most uh feasible or impactful for residents is to take on in your suggestion and your experience for us.

SPEAKER_01

Yeah, and that's what I was uh saying is that I think choosing your research project is important, depending on whether you're going to have dedicated time versus trying to fit it in between your clinical duties, and also depending on how long of a time frame you have, that should help you choose the type of research pro um type of research projects that you're looking at, um, whether there are time dated versus things that you can do on the off hours.

SPEAKER_04

Yeah, I I think I'll take this first. So I think important projects are uh very clinically related, so things that you know, patient, um, you know, patient safety, quality improvement projects, so things that can get done quickly. So, you know, maybe for example, hand washing before a certain procedure, extra hand washing. So you you know you measure the outcomes at one point in time and then you have an intervention and then you measure the outcomes later. Things that you can do very quickly over in a month, three months or six months so that you can acquire the data quickly and put it together, or um, you know, a new technique where you where you measure the outcomes of a new technique and a surgical procedure so you can kind of see um the outcomes right there uh in the clinic rapidly, and then also um acquire a lot of patients quickly into a clinical study, or something where you're just kind of changing protocols, you know, like length of stay in the hospital, you know, sending patients home after three days instead of you know, two days instead of three days for like a free flap. So you can kind of see the outcomes in real time, and you're also living it and breathing it on the on the um on the wards or in the clinic. So things that I would say things that are very applicable to your practice that you are excited about, that you can see the results of and be involved with the data collection in real time. That that those are helpful clinical projects. Those are the ones that I get involved with routinely and also ones that I recommend for medical students and residents and fellows that are working with me in a short period of time.

SPEAKER_00

Do you also think that mentorship is also important there? And uh is there any research traps that you should think that residents should avoid?

SPEAKER_03

So I I think you know there's different kinds of research projects, um, clinical, mostly computer-based work that's a little bit more flexible, um, or research projects that integrate more into your clinical day-to-day workflow. So I think the first two years you're really getting a feel for what your days look like. Um, and I would actually advise a lot of residents to get a feel for that workflow first before committing to any large projects, because if that workflow of the project flows well with your day-to-day, then that's actually a great project. But and I kind of learned this the hard way. If you if you have to do like clinical data points every three hours for like three days, that's probably not the best project for you as a resident. Um, I do know some people who um in residency did basic science research and uh uh lab-based research. I'm still not sure how they did it. Um they're amazing human beings, but again, it was a priority for them.

SPEAKER_01

And I also want to go back to mentorship. Um, I know all of us have benefited from mentoring, um, and I think that makes a big difference, especially in research. So finding that right mentor who's excited about the things you're excited about, who's willing, and uh invested hopefully in your advancement as well, that makes a huge difference in your research.

SPEAKER_04

Yeah, mentorship is critical. So you need somebody that can uh take you from the beginning to the end of the project, who can guide you through the process, who can see the pitfalls, that can motivate you. Because if you don't have that person behind you helping you, the project could languish and the project could start, not finish, and you need the resources and the time and somebody helping you get that project to completion. So mentorship is critical, especially for idea generation and the practicality of the of the clinical question.

SPEAKER_01

For sure. And I think that ties into one of the pitfalls, which is sometimes uh people don't ask for help. They say everything's fine, you have a meeting and you say it's it's great, I'm working on it, but really you're stuck and really not being afraid to ask for help when really that is research, it is a team effort, and your mentors and the other people on your research team can help you say, wait a second, I've tried that before, don't do that, try this. You know, there are things out there, um, it is it is not a solo sport.

SPEAKER_03

Yeah, definitely echoing off of that. Um, I have benefit hugely for my mentors, including Dr. Jekyrus and Dr. Sachs. And actually, one of the big pearls that Dr. Sachs gave me when I was um when we were doing research together is that most projects is driven forward by someone who wakes up every single day, and that's like their agenda, they're driving that a project forward. And I think one of the things I've learned in residency is just being really honest with myself about how much uh bandwidth I have for certain projects and looking at the team that's involved for the project. What are the team members? Is there someone on that team that can drive the project forward every day? Um, and what can I realistically give to this project?

SPEAKER_04

Yeah, I mean that what Dr. Shun said is so critical. The ability to say yes and also the ability to say no. You have to be able to say no to certain things so you can say yes to other things.

SPEAKER_00

Thank you so much for pointing it out. Uh I really agree with everything that you've said and also the team work during the residency, and uh the relation between residents is also important to uh empower each other, and there's also a mentor that also supports that. Um now I would like to uh talk about your own projects during your residencies. Is there any specific clinical research or projects that uh you've been involved that you would like to share with us? That you have some good memories or even some maybe bad experience that you would like to share with us.

Personal Project Journeys And Lessons

SPEAKER_03

Uh yeah, I can start with talking about some of the work that I've been doing. So I I think the luxury in residency is that now you can really focus on projects that you're passionate about. And for me, um I'm applying into microsurgery, and so the last few years I've been trying to work on more projects specifically targeting microsurgery. And we're pretty lucky we have a really robust uh research team of research assistants, and so um I do a lot more clinical-based research now where if there is a question that merges in clinic, or if there's a question that merges in the OR, I'll bounce the idea off of the research team, and then they really are the machine behind a lot of the clinical projects that we end up doing. And uh I've always had an interest in surgical devices and surgical device development, and so another project I've been working on is um in collaboration with the Harvard School of Engineering and being able to work with some of the engineering students there to develop ideas.

SPEAKER_00

Okay. Well, how about uh would I also like to ask the same question, uh Dr. Jefferson and Dr. Sachs?

SPEAKER_01

Yeah, I'm trying to think um through my time, and I think this is important to say, you can be involved in many types of different research. Um I've been involved in things that are more wet lab, where you've got specimens that you're processing, you make slides, you stain them, you do monoclonal antibodies, trying to see what happens and trying to figure out a um uh finding from that, as well as looking at prepared slides to look at the uh development of, in my case, soft palate structures in um throughout that time, trying to figure out what causes um sort of the morphogenesis of cleft palates, for example, as well as going abroad and just going to um different labs to see how they were at that time was a bigger deal about making doing palatal whole organ cultures. That was a fun thing as well. But then as my time matured, sort of referring back to what I said earlier, having less time to be able to go to a lab with timed endpoints and so forth, pivoted more to things that were clinical, um things that had to do with outcomes, um, as well as looking at more recently technology and AI and uh how that affects plastic surgery. So a full gamut of things that you can do throughout your career, and it just adjusts depending on what you were doing at the time, and again to what Dr. Shun was saying, what your time commitment can be. Um, that really makes a difference. But the underpinning of all of that is back to what Dr. Sachs is saying. The curiosity of like, I wonder why this is, or I wonder what the real finding would be for X, Y, and Z, because you want to know the answer, and that's really what drives everything.

SPEAKER_04

That's a great response. And I was thinking about my training. Um, so I did combined uh general surgery and plastic surgery. It was a combined program, so three and three, and we had no 80-hour work restrictions, so there was no work restrictions, so I just I never went home, I was on call all the time, and I was the only one in my year. I was at Mount Sinai Hospital um in New York City. I think now they have you know 24 residents. Back then we only had five, and so we covered the whole system, and I just worked nonstop clinically. And uh, I think I wrote one paper, Midline Cleft. Uh it was like a retrospective review for a Midline Cleft paper with Lester Silver, who's the chief of the time, and then I wrote a um a book chapter on um body contour surgery after massive weight loss, because we were doing a ton of massive weight loss patients. Uh, it was all laparoscopic ruined wise back then. And so I didn't have much time to do clinical research in my training, uh, different than what our residents now have, where they have genius time and uh uh they they're forced to do a project and they can take a year off. So what I did at the end of my training was I went to Pittsburgh, um Department of Plastary at Pittsburgh, and I took um three years off. So I finished my sixth years of training, and then I went to Pittsburgh for year seven, eight, and nine, and I worked in the basic science lab for three years, and I also did a hand fellowship there. Um and then I did another PGY tenure at MD Anderson after that. So I was doing basic science and clinical research in my seventh, eighth, and ninth year full time. I was also a clinical fellow. So that was back then because we didn't have that kind of protected time or focused time during residency. And it was the best move of my life to do that, um, understanding how to do basic science and critical research and you know, kind of set my career up in a different trajectory had I not done that. So, you know, to to just use myself as an example, had I not gone to Pittsburgh after Mount Sana in New York, I would not, you know, have this role now and watch you um School of Medicine in St. Louis, you know, being this, being a leader, uh doing research all these years later, had I not done that that research gap three years. And and that's just because of the times. Like we didn't have the ability to do the research during training because we were just we never slept and we never left the hospital. And it's and that's different now. It's literally you you I mean, you have to go home. And our residents get the day off the next day. So if you're up all night, you get the day off. And so, you know, you'll sleep, and then you should be able to do research and self-care and all the other cool things that people do nowadays, you know, avocado toast and and uh all the you know culture stuff.

Beyond Clinics: Education, Policy, Innovation

SPEAKER_01

Actually, I also think it's worth mentioning too, now that I'm thinking of this, you know, we're talking mostly here about basic science and clinical research, but now there's so many other opportunities as far as what Dr. Shen alluded to, which was um translational research or even entrepreneurship and innovation that ends in medtech. Um there's uh a number of opportunities out there. There's also um research that we haven't mentioned in academics as far as the education and how we train residents and how we train physicians, but also finally on health policy and how that affects what we do. So there are many more arenas that I think are quote unquote more acceptable from an academic standpoint than they were probably uh during the time that we trained.

SPEAKER_04

Oh, yeah. I mean, education research now is tremendous. You can be an educator, you get a PhD in surgical education, and that could be your line of research, and that's great stuff. How to teach, how to train. There's huge opportunities just in the evaluation for competency-based education across the whole world. You know, we have to be better at training residents, and that's a whole opportunity to do research around that, and that's the kind of stuff that you know it doesn't require a lot of time away from your training to do that.

SPEAKER_03

Yeah, definitely. On the note of education and research, I think there's a lot of things that residents do in the day-to-day that could easily become research. So, for example, if you're putting together a microsurgery workshop for yourself and the other residents, you can just, you know, make it add a couple of steps and make that into a research project as well, um, and share that with uh your other co-residents and peers around the country. There the opportunity is definitely there.

SPEAKER_00

I also agree with you, and uh, I would like also to add that also right now, nowadays, as uh this is also uh uh international residence uh forum that we are talking now. Uh also international uh projects, international co-working and research, that is something that I would say it's much easier now for us to do in our residences. Um I would also like to ask you how has your involvement in research influenced your perspective on plastic surgery overall, or doing those basic science and uh clinical researches, all kind of research that you did during your residency, uh, did have any uh impacts on your future career.

Getting Started: Roles, Reviews, Networks

SPEAKER_01

I was thinking about that. I mean, there's many different ways that it can affect your career. Number one, the most obvious ones are if you end up in, you know, you start to do research, and of course you end up in the academic career where you continue doing groundbreaking research. I, of course, am private practice and didn't do that, but it was important to me that I continued to work on research in one way or another. So being involved in clinical research in our post-approval studies for some of our implants, I was a medical monitor for one of them. There were um there were other multi-site um projects that I was involved in just because it was something that I was interested in doing. But I think from a personal standpoint, it really was a way of critically thinking about ideas and problems, but more um broadly was really the connection with other people who were just interested in innovation and interested in answering questions and asking the whys. And that really um, I think it was Dr. Shand who said this, but sometimes it gives you this other perspective beyond the thing that you're doing day to day, and it gives you a whole nother community and networking across the country to um really have a lot of fun with. So for me, it's a sort of addition to the rest of my life.

SPEAKER_04

Yeah, and I think that doing research just makes you better, and the the some of the best surgeons in the world, and you know, and there's always an exception, but some of the best surgeons in the world also do some of the best clinical research. And sometimes, you know, you don't have to be uh a PhD level researcher with statistical knowledge, even some of the best papers that I look at that I love to read are the single author papers of 50 cases or a hundred cases of a surgical technique by one master surgeon. Because just the the ability to critically review your work and ask a question is did what you do change this outcome, make it better, or make it worse? Those are sometimes the best clinical papers, like the single author where somebody is a master of their craft and they critically assess what they do. And you don't need you know, you don't need a big research engine to do that. You just need to be able to uh document your results, take some pictures and look back critically. So I think you could do research that way, or you can do you know multi-institutional and higher-powered research where you ask bigger questions and scale it to hundreds of thousands, if not millions, of patients. But I do think that you know, being asking a question and then uh gathering data and analyzing data and then drawing conclusions from that data makes you a better surgeon and makes you a better clinician and makes you that you know, just opens up your mind to different things and just I think it just makes you a better person.

SPEAKER_03

Yeah, definitely. And I I think um as someone who wants to stay in academia, I think it's been really helpful to look at research projects within every subspecialty and looking at my attendings in those subspecialties and trying to understand what a career would look like doing both research and the clinical work. And I've discovered that for some I love the surgeries, but the research projects don't really light my soul the the same way that others do. Um, and so you know, microsurgery was the ultimate choice for me because I love the research side from a lot of the work I had done originally with Dr. Sachs and continue to do here as well, um, but also the clinical practice, so finding that balance. And maybe as a resident you find out that you don't like research, and that's totally okay. There's something else that you really, really enjoyed, but at least you gave it a shot and you you kind of let that experience guide your next steps when you're planning your career. And I think for me as a resident, what's really, really refreshing and brings me a lot of happiness is being able to speak to other people about the research projects and getting a more diverse perspective. So we get a lot of visiting residents and Faculty members from all over the world, and some of the best parts of my days like talking to them, like hearing about how they do things, or going to an intro uh a conference and meeting people from uh globally and just hearing the like really awesome ideas that they have, and I'm just like, wow, like how did we not think of that? Like, let's definitely try it. So I I really do think it enriches and um diversifies our education.

SPEAKER_00

Thank you so much. Uh I would also like to ask you about advices for uh aspiring res researchers. Is there any advice you would give to current residents who hasn't been uh committed to research yet or uh where to start? Um also I would like to mention PRS uh opportunities that I could they can be peer reviewers or something like that. What do you suggest uh for the start?

Big Takeaway: Just Start And Keep Going

SPEAKER_04

I would I would suggest all the above what you mentioned. I think being a peer reviewer is great. You get to read about the research, you get to create a structure of questions of what how you analyze a paper, and once you do one, you get comfortable, once you do ten or a hundred of them, you get even more comfortable. I think it's sometimes anxiety-producing or daunting to jump into a research project, a lead on your own. Find a research project that you could be a co-author on, where you could help write the discussion or help analyze the charts. Just be part of it and then learn the process of it. Go to research meetings at your institution, find out who's doing research, ask around, and then join the project and show up. Nobody will ever turn away a researcher. And Helen Sean will tell you we had a weekly research meeting, head-to-toe research meeting, where we listed all the projects on one page. And Helen, we're still doing it here at WashU six years later, you know, after leaving Baltimore. And you just need to find people who are interested in asking questions and doing research. And there's always somebody out there who will be more than happy to show you the way forward. And don't be afraid if you've never done it before. And also, you have all these now, you have all these large language learning models. You can just ask the question, how do I do clinical research? It'll tell you, and then study it, and then implement it and help people do the work. Just be part of a team and you'll learn how to do it and then jump into it.

SPEAKER_00

Thank you.

SPEAKER_01

I totally agree. You um I think sometimes people are intimidated, especially if you haven't done it, and you think, oh my goodness, how am I going to drive to back to what Dr. Shun said about drive some sort of project? You don't have to do that to begin with. See what other people are doing and see if you could help to start with. Or to Dr. Sachs Point, if you're at, you can go to some of these meetings and see what projects are out there, and which one of them, uh, like Dr. Shun said, lights your soul, and you say, Wow, I want to be a part of that, you know, and which one of them are feasible for you to be involved in based on time or your um or your expertise. And that's where the mentorship comes in. And don't be afraid to just cold cold um reaching out to people you don't know just because you're interested in what they're working on. Like Dr. Sag says, most people will not turn away somebody who wants to help them.

SPEAKER_03

Yeah. And I think a main piece of advice for residents is that research should enhance your training but not replace it. So at the end of the day, like these are really valuable training years, and your priority should be your training and learning the surgeries and patient care. Um, but the research is an important component for that as well and should be taken seriously. Um, and one of the my favorite things I've done during residency is getting more involved with the societies. Um, and I definitely have to credit a lot of that to Dr. Jeffers and Dr. Sachs for helping me get involved there. Um, and it's just helped um create a new perspective uh for a lot of the work that's being done, but then also opening the door to a lot of different uh mentors and seeing what their practice is like and uh using things that takeaways from that uh for what I envision for my future practice, too.

unknown

Yeah.

SPEAKER_04

I think I also let me just say this. I can't tell you if you look at research papers through the years and you look at authors and co-authors, guaranteed that many of those people that work on projects together on papers in certain places work together in the future. You build these bonds together with people that you do research when you ask questions and you do the hard work and you're able to get a publication or a podium presentation. It's really uh what I would say clinical research during I would say clinical research during your during your residency is a network um networking opportunity at scale, because what happens is you build a network in your institution where you're doing research, then you get to travel to another place at some point, present that research, and then you publish it, and everybody reads it. And so your network is just expanded at scale, and so you should just do it. It's so beneficial. It's so many, it's so beneficial on so many levels that not to do it is detrimental to you, I think. And so it's important to dive into it in any capacity, even in the smallest of capacity.

SPEAKER_01

And I think that was what I was going to say is just do it is a great attitude because there's no better time to do it than um residency before you leave, because depending on where you're going and what you're gonna do, you may or may not have access to the fund, you know, the fund and the resources of wherever you're training. Having said that, you know, it research formal research isn't for everyone, and that's okay. You might do it and suddenly realize, you know what, I thought I wanted to do research, and actually, this is not what makes me excited. This is not what I want to do, and that's okay too. But I would also argue that most of us, even if we don't do formal research, by the very nature of being plastic surgeons, we are curious by nature, and every day we embark in that sort of research um mode where you're asking questions and answering. You just may or may not be publishing it, and you just may or may not doing it, be doing any formal research. But that's okay. That also contributes as well. I think just the exposure and trying um gives you that mindset and gives you an understanding when you're evaluating it and when you're talking to people who are doing the research.

SPEAKER_00

Thank you so much for everything you said. Uh this episode has come to an end. So I would like to thank you for a really insightful conversation. And before we uh wrap up, uh, what is one takeaway uh you'd want residents to walk away with uh about the level of clinical research and plastic surgery training and residency?

SPEAKER_02

Just do it. Just do it.

SPEAKER_04

Yeah, I I I'll I'll I'll say that again. I think you know, in life, there's always it's always easy to say no, but sometimes, you know, the hardest part is to say yes and engage. And I'm telling you, any part that you take in getting a clinical research project to a manuscript or to a podium presentation at a local, regional, national, international meeting, I think it will be will change your life for the better. You'll remember it, uh, you'll be you'll think differently, it'll make you uh smarter, it'll build your network, you'll help the team, and and ultimately what you'll do is if it's really good research, you'll improve patient outcomes. If you can Google or PubMed or you know, find a paper that helps you do a surgery better, or teach better, or do basic science experiment better, you've now made patients better. So I I think everybody who's listening to this, I get going, get started, don't stop, do clinical research, and uh, you know, and you know, just do it as Helen said.

SPEAKER_01

I'm gonna modify that to say that um think outside the box. Just try it. You might like it.

SPEAKER_02

Try it.

SPEAKER_00

Thank you so much for your honest opinions, and it's really appreciated by residents for sure. I want to thank uh Dr. Jeffers, Dr. Sachs, and Dr. Sean for coming on today's uh episode to talk about clinical research in plastic surgery residency. I look forward to seeing more uh works from you on this topic. Uh and uh and thank you so much for being here.

SPEAKER_01

Thank you.

SPEAKER_04

Thanks, Elton. Thanks so much for inviting us and having us here. Great this great to hear everybody.