An Interview with Dr. Stephen Parada

Q: What do you think of when you think of research? Why do you think research is important?

Research is the process that we as physicians use to figure out answers to the questions that we have about taking care of our patients. Ultimately, research allows us to provide better care to our patients.
I think it’s so important to learn the process of research as a resident, so then as you progress you’re able to use the skills learned to perform the research that you want to perform and answer the questions that you have about your own patients. The key is to get involved with some type of research as a resident so that you can learn this process so that you’re better equipped to perform the research that’s important to you as you move forward.

Q: Talk about your method (the system you use to move an idea through to publication/presentation). Is it the same for all types of projects? Have you changed anything about your approach as you’ve gained more experience?

My approach has constantly evolved as I progressed with my own research experience. I’ve learned all throughout my career, learning from my mentors throughout the different stages of my career. I continue to learn ways to be more efficient with performing research by collaborating with different friends from different institutions. SOMOS has really opened doors for me to perform collaborative research with many other orthopedic surgeons that I’ve never trained with or have been stationed with.

Obviously, the research process starts with a question. The first step is going to the literature to see if this question has already been answered. Often times you will find that the question has been partly answered, but there is still an angle that has not been explored. At this point, I think it is key to define:

1. the purpose of the study
2. the hypothesis of the study
3. your teammates who will help take this question through the phases of becoming published research.

Next we begin to develop the methods. This part typically takes a little bit of time to make sure that we have the methods completely fleshed out before we try to gather data. This is also when we will seek approval from an institutional review board if applicable. Next for me is to develop an outline. The person who developed the question should be the one who writes the outline for the introduction. The information for the introduction is already known, because this is the background information that led to the clinical question to begin with. The introduction ends with the purpose and the hypothesis which have already been developed.

The methods have already been decided upon, so this is a part where a more junior person on the team can contribute. They write in the methods, step-by-step.

The results we will leave blank for now as we haven’t gotten these back yet.

Lastly is the discussion. The discussion is also framed by the senior author in outline form. Usually I write this in bullet point format and we start adding in references through a bibliography software. They are going to be several introductory articles that are going to be included in the discussion regardless of the results, the rest of the discussion will be framed by the results, but again this is the senior author’s story to tell. Leaving the creation of the discussion to the junior most person on the team is a common cause of failure of an article to get published or a significant delay. Although this is time consuming, senior members of the team should have oversight during this phase.

At this point, we have selected our team, we have a clinical question, we have defined our purpose and our hypothesis. We have finalized our methods, the outline of the discussion is written. Now all we need to do is to collect our results and finalize our discussion so that we can come up with our conclusions. The target journal is selected before we even do the outline so that everything can be written in the correct format for the selected journal.

This is the model that I’ve come up with from learning from many of my research mentors over the years and seems to be the most reproducible for me to teach to others.

Q: What are some of the most challenging parts of research and how would you advise someone in dealing with them?

One of the most challenging part of research can be the time necessary to devote to this. There is typically heavy upfront costs of time as someone learns the research process. Working with a mentor is key so that you can learn from them and not have to constantly feel like you are reinventing the wheel or learning through trial and error. As you progress with your research experience, the time needed will decrease substantially.

Another key is defining those who are allies in your institution. Allies could be key personnel in other departments that you can collaborate with, or people within your IRB who can help you get projects through to completion. The bottom line is that institutional support is a huge plus, but not an absolute must. I’ve worked in many different systems and they all have had varying levels of support.

A research assistant can be crucial to help with all the rate limiting steps of getting projects through to completion such as IRB submission, collation of information, chasing down signatures in submission. We offer a 1 to 2 year position for college graduates who are looking to take a gap year or two to increase their research productivity before applying to medical school.

Q: What advice would you give to someone who is interested in research but doesn’t have all of the typical resources of a large well supported tertiary academic university setting?

Collaboration is key! There are many other surgeons, especially through the SOMOS community who will be very willing to collaborate with you. Again, I’ve collaborated with dozens of authors from institutions that I’ve never attended. Demonstrating your willingness to participate will reap substantial benefits. I think it’s in very important to not have large gaps of time with no research on your CV if you are looking to stay relevant. Ultimately, we can all control how much time we are willing to invest in this, and there are countless examples of leading researchers who have very little institutional support and aren’t even in academic positions.

Q: Is there a time or set of conditions where you would recommend moving on from a project or study you’re currently involved in?

Knowing when to move on is a very difficult decision. Many research projects make it all the way to the manuscript stage and then go nowhere. Others die out earlier in the process. I am a big advocate for not letting research projects drag out too long unless they have a champion. I’ve personally had a couple projects take years to complete that I am very proud of, but I’ve also chopped many projects that weren’t going anywhere, so we could shift focus to other projects. This is a hard spot for a junior person to be in, so again, it is important to have a mentor who can have this conversation on your behalf. I am happy to talk to other staff on behalf of our residents and let them know that it doesn’t look like their project is going anywhere and maybe it’s time to shift the focus somewhere else. Sometimes this provides motivation to get a project finished, and sometimes the best thing is that we just take the project out back and put a bullet in it.

Q: What’s the greatest number of journals you’ve submitted prior to publication? What’s the least?

I was zero for five for submitting to the yellow journal (JAAOS) before I finally got a project accepted! I had a project rejected from AJSM the day I submitted it! I’ve had a project shot down from four journals before it was finally accepted! If your research experience is not littered with failures, then you are probably not doing too much. I always offer my opinion over which tier of journals should be our goal for our target journal, but I also let residents decide if they want to “aim higher”. There are different goals of each projects. Some of the articles are going to be practice changing, some of the projects are going to be a vehicle to introduce other residents or junior personnel to research. These two different scenarios will have vastly different target journals.

Q: Is there any research you’ve done in the past or have going currently that you’re especially enthusiastic about?

There was an idea that I had in fellowship about coming up with an easier way to measure glenoid bone loss that stalled multiple times. I tried to get someone from the Harvard math department to assist me with the calculations, and it just kept falling through. Ultimately, my wife and I spent a couple evenings with a scientific calculator and digging out some old geometry books to figure out the math (she ended up being a co-author for her contributions). Then I needed to test my theory, and kept striking out looking for volunteers to make measurements for me. It took five years and working at three different institutions to finally get the project to the point where I was happy with it, but I knew we had come up with something special. The project ultimately was presented at multiple national meetings and won a research award from the arthroscopy journal. I termed our new technique the circle line method (CLM) which also was a tribute to my kids: Camden, Lincoln and Mason. I felt like we all deserved a lifetime achievement award after finally pushing that thing through to publication!

Follow up questions:

Q: How has SOMOS specifically opened doors to perform collaborative research with other orthopedic surgeons you’ve never trained with or have been stationed with? What SOMOS resources would you direct someone to that is interested in research and becoming involved with research projects?

One of the great things about SOMOS is how open everyone has been to meeting and getting to know young members. Obviously, the best opportunity is at the annual SOMOS meeting, but then relationships can be continued to expand at other national and regional meetings. Getting to know other members and then collaborating with them takes initiative, but is well worth it.

Q: Is there anything in your process of research you spend more time on now and focus on more now than you did earlier on in your career? Anything you spend less time on or focus on less?

I continue to spend more “up front” time really making sure we have a good idea and the plan is solid before proceeding. Early on in my career it seemed that we would get an idea and run with it and then realize that there were a lot of fatal flaws in the project, but realize them too late. The preparation phase of the project is now what I prioritize.

Q: You mentioned you learned some of the necessary geometry to complete your CLM project, have you done anything similar with statistical methods in other projects? What is your typical approach to statistics? What has been your process?

I did not need formal statistical analysis help on many of my early projects, but as our projects become more and more intricate, there is a need for statistical analysis that is beyond what I can provide. I have found that medical students are a great answer to this problem. Often times they have undergraduate statistical majors or at least fields of study where they can perform the complex statistics for us. This is also a great part of the project to be done remotely, so I’ve worked with medical students even from other institutions to help with this. I’ve also found other personnel with statistical backgrounds have been willing to collaborate even though they are not within my department. Basic software such as excel and SAS is also very beneficial, and there are a lot of resources on the Internet to help learn this better. This was definitely not in my skill set, so I spent a lot of time taking advantage of these resources and the people around me with a better understanding to improve in this area.