There is just a very simple things that we're going to run through with this Scholar 7. If you commit to be with me for the next seven lectures, I know that's a lot, and we're going to try to organize them so everyone can attend. I hope to promise you that at the end of this, you'll have a scholarly project. It's called Scholarly 7 because there are seven lectures. It's a series of seven hands-on workshops, and we're going to explore the development of a scholarly project. The problem was, how do you become scholarly? How are you scholarly in a private practice situation? How do you become scholarly in a small hospital setting? How do you become scholarly in a large hospital setting? You've got to know the definition, though. Scholarly is having or showing knowledge, learning, or devotion to academic pursuits. There's a place where, if you're seeing a lot of patients per day, and you've got a busy practice, and you have to do this scholarship, how do you fit that in between? What is very important is how you get it done, how you move through the process. That process is the hypothesis, and it's the initial sentence. It's one simple sentence. It's a method. It's the results. It's development of the abstract. It's development of the poster, development of the manuscript. It doesn't really have to even be specific to anything. It doesn't have to be specific to your own. It could be just a general topic. It has to have some kind of culture. When the fellows leave my fellowship, they have a pen, and on their pen are these three words, intensity, consistency, and courage. I think that's very important for us to have, especially as community physicians, is to be able to recognize that as long as we hold steady and move in one direction and with focus, this is not scary at all. We can complete this, and we can have a scholarly work that we can generate for our institution and for ourselves. The intensity, so it's serious concern for scholarly work. We just have to take it seriously. That's all. It's there. It's a team concept to move the project forward, and I think you'll find, once you mention this to an intern or resident, they get very excited. I can't tell you. They just were waiting for this opportunity. They get very excited, and they take hold of it. The students take hold of it. It has a life of its own. You have to create that life throughout your practice. You can meet weekly. It depends. We'll talk about this as we go on, and then the objective is, again, it's doing these same things, and we're going to go through each one of them, the hypothesis, the method, the results, the abstracts, the posters. Consistency. Maintain a serious approach to it throughout the year. You might not get to the point where you're publishing. That's okay. You may not get there where you're creating a poster. That's okay. But you may get there where you're writing an abstract and submitting an abstract. That's scholarly work. You might not get to the abstract. You might just get a hypothesis where you're examining and get some data. Might not be. It may not be the results you want, but it's still scholarly work. It's still enough to put the title, the people working on it, the stage that you're at. That's scholarly work. Weekly team research meetings consistently, quarterly research review meetings with the attendings and DME, internal presentations of your research. Celebrate the scholarly activity like Mike does at Richmond with our research day. Courage. This study that we're going to do, it's going to force you to shatter your perceived limitations. You're going to reach for meetings. You're going to be able to present at national meetings you thought you never could do before. You're going to be able to reach the journals that you thought that maybe I'm not going to be able to do, but you're going to get that courage to move past this limitation that you think that exists in doing scholarly work. It will give you a perspective. Research is about simplicity. The least amount of words is good. It's about developing a simple hypothesis and also understanding this is not hard. I know it sounds hard, but this is not hard. I've repeated this, repeated this for seven, eight years, and I've done it over and over again, and I publish every time, and I do things all the time. You can all do it too. It will provide memories of good and bad that will fuel you in future endeavors. As you move through, the more times you do it, the better you get at it. Practice makes perfect. Every time you go through this sequence of things that I'm going to teach you, you do it. The more time you do it, the better it comes out every time. It's development. What you want to probably try to have, and I think this is important, parts of it, is this community. I think that's key, or having someone, at least a medical student, to be able to do key literature searches. That's really important. We'll talk about that as well. A DME that's helpful, an optee, lecture halls, and of course EMR, that's a treasure trove of scholarly work, EMR, especially if you can use the entire system, not just one hospital, but the entire system which is available. The statistician, which is available through the optee. Large practice, whether it's inpatient or outpatient, is a treasure trove of scholarly work. IRB, which we can help, we'll help you through, and of course mentoring, and what we're trying to do is serve as a general mentor for all departments in our sites. So the library might be at your site, but it may not be. It might be another site, but there'll be a librarian. You want to do a literature search. You want to pull the articles. Best to get the entire article. When you pull articles, don't pull just the abstract, get the entire article. Have the student pull the entire article. Have the articles laid out in front of you whenever you're doing your work. Literature searches, make sure that your topic is unique. That's the only problem about a hypothesis, it has to be unique, it has to fit someplace. It has to be a piece of the puzzle. So it could be a piece of the puzzle, it's a piece in the middle of the puzzle, and that's okay. Maybe in the literature there was a hole, someone jumped, and maybe that's the hole you're going to put your piece of information in. Or maybe it's an addition to the end of a string of literature. So maybe it's not in the middle, maybe it's at the end. It's adding something to the end. Don't use Google. Never use Google. Just go to PubMed. If you're going to use one place to do your literature search, PubMed it. And then have the librarian pull those articles, or the medical student pull those articles. But review the articles yourself before you have them pulled. Your DME, the support of your scholarly work, at least to develop lectures towards basic knowledge usable by the team, like we're doing today. We'll be bringing experts, people in the IRB, people to teach students and residents how to speak, writing, grants, and et cetera. The OPTI is for supportive grants. So you're going to find, once we start writing things, maybe even tonight, and maybe in the next following lectures, you might look at this and say, boy, this looks like a grant. This is like something I could send out. And writing through LECOM's OPTI is a great way of starting. Lecture halls, this is a great lecture hall. This is a place where you can practice, and scholarly work is about practice. So a practice arena for the trainees. So if they're going to present, you bring them into these kind of lecture halls and have them present over and over again. This is the beginning of a speaking component. Scholarly work also includes speaking, giving grand rounds and other lectures, and it should be on site. Your EMR. Your EMR is a data reserve. There's tons of information in there. And just to get started, if you just want to get started in scholarly work, and we have to get started, just looking at the EMR, making a hypothesis that's specific to your practice in the EMR, and doing the retrospective analysis of that data is scholarly work. It's fun. You could find the tons of stuff you could find. There's a lot of stuff in it, and you're utilizing the entire system. So it's a source of one type of research, and you can use that to challenge myths. We all have myths in our practice, and it's, for example, for asthma. So if we discharge someone with an asthma, do we use high-dose or low-dose prednisone discharging from the hospital? And does that have any influence on the 30-day readmission? Well, believe it or not, there's not a lot of great data on there. A lot of small data. A lot of small studies. Tiny studies, about 30 and 40. And then at the end, it was a meta-analysis that looked through all those studies. So it was a meta-analysis of a bunch of small studies. Oh, by the way, they're all done, none of them were done in the U.S. What a great study. A large American institution getting larger numbers, looking at whether high-dose or low-dose prednisone is adequate. So that's the kind of question. That's the kind of myth. And you can give that one to each class or several groups and run that through your system. And again, it doesn't have to be limited to your hospital. You can expand that to the entire system. You can use inpatient, outpatient. This is a great site for case presentation. Now, you know, case presentations, some people don't think those are very sexy. I love them. They're low-lying fruit. They're still scholarly. You can still get an abstract of a case presentation. It can go into a poster. It can go sometimes even to oral presentations. But it'll be referenced. And if you write it up and you put it in a manuscript, I've had case presentations referenced in textbooks. How great is that? That happens. But you have to be key about looking at the case. Is it unique enough? So you have to really dissect the literature. And even you've got to find that little hook. It's a little hook where you just set up and just, that's where that case belongs. And it works. The hook always works. So quality improvement studies, these are great as well. So these can be done. These can be presented at any of the local meetings or state meetings and even some of the national meetings. One of our quality improvement studies are very simple, was we have several people on allergy shots in our practice. And then we looked at, say, how many of those come into the office every year to be evaluated on their shots. Well, it turned out there was a large population that just kept on coming in for shots. And it never came to see us. So it was a study to see how we can improve that. So that's a quality improvement study. And that is part of ACGME as well. But that's a good scholarly work as well. We can put that together, and we can write it up and publish it as well. So there's always these pearls that are given by the attendings that, you know, these kinds of things. Here's what I do, and here's the pearl. Now, is it true or is it a myth? We all follow these things. We all look at things we've heard over and over again. Is there literature to back it? You wouldn't believe how many of the things we do aren't backed by literature. That's a myth. Dispel the myth. Easy enough. So again, a source of research data, use your EMR. So case reports. So if you do case reports, they can be done very quickly. As we go through this, we'll teach you. But it can be done over a few weeks, a good case report. It can be a part of a new treatment, a new presentation of a disease, a response to treatment. Maybe it's a quicker response to treatment. And you got to check through PubMed. It's important. Go through PubMed and put down the different names for that disease, different names for the treatment options, and then put it together. Draw out the data and see if there's ever been. If there's nothing ever been reported, it's terrific. You got the whole. There's the whole. There's the missing piece in the puzzle, or it's the end of the line of a piece of parts of data. So that works very well. Quality improvement studies. We all need quality improvement studies for the ACGME alignment. The intent is to improve the quality of a particular practice in medicine. It may be done within a private practice, academic institution. And all of these that we're going to be talking about, we need to review through the IRB. Osteopathic focused research, easy. These can be done as well. And easy enough, developing modules. Mike and I spent a lifetime developing osteopathic modules for the pediatric profession, a list of 23. Developing those, you can do LICH search and find out that there's data behind some of the things we do are sparse. But that's a good place to be, too. Sparse areas grow good trees. So types of work, OMT module development for your specialty, or OMT used at various disease processes. So the OMT modules are very simple. A simple PowerPoint program, 20 slides. There's a module to develop research protocols. And the components for us, when we were developing these components, mostly intro into the bio AT still, intro to subjects, baseball injuries, or basketball injuries, or other components of osteopathic profession, anatomy review, the treatment, and then three subsequent questions. And that's scholarly work. So those all count as well. So your timetable, it's really important. And actually, when we went through this with the internal medicine, and we were looking at the prednisone dose, and the hypothesis was actually, statement is that inpatients admitted for asthma on discharge, if they were discharged on low prednisone dose, that the 30-day readmission rate would be low. And that was just the hypothesis. And so you want to judge your time. So we looked at, so where could we submit that to, starting now? And if you looked at the meetings, and there was one, American Thoracic Society would be in October. So that would be a good place for us to go. So that's our drop-dead date. We have to find a meeting. And it could be the AOA meeting, could be your sub-specialty, ACOI. It could be ACOP. It could be a sports medicine. But it's that place where that's drop-dead. That's where we want our abstract. That's the submission date. We need to first establish that. A good case report, again, is turned around a few weeks. EMR and quality improvement studies would take several months. But that's what you have. You have an entire year. You start it early, and you move it throughout the year. And you can get that done nicely. It's impossible to do bench. I think when we think about scholarly work, we say, oh, bench, pipettes, and all that. Well, it's not that. I did bench. I did bench as a fellow at University of Alabama for three years. I did bench for nine years at Rainbow Babies and Children's Hospital. And it was a bear. And now I'm out doing the same stuff, but stuff I really like to do in clinical practice. So you're not doing bench. Try to link the studies to your interns, your residents, and attendings. Get as many people involved in the studies as you can, especially the attendings. Move everybody in, get them involved in the study, especially if they have a passion for it, because the more people you get involved, the more credit we get. You get street credit. All right, so here comes the challenging part. Believe me, this is probably the hardest part, is hypothesis development. So hypothesis, this is a tentative explanation of observation. We do observations every day. When we're seeing patients in the office, this is what we'll need to do. It's a phenomenon or a scientific problem that can be tested by further investigation. Key terms, and again, this is the sentence I'm gonna ask you to make tonight. This is the one sentence, one sentence I just want you to do. So it's a statement. It's not a question. You're not asking a question. It's just a statement. And it's as if you believe this to be true, but you're going to prove it or disprove it. But it's not a question. If it comes out to a question, pick one side or the other and stick with one side. And at the end of the day, it doesn't matter whether you prove it or disprove it. It's still data. It's still scholarly. So that's the courage that you have to keep going. It's got to be clear, focused, and simple. The least amount of words is better. It's got to be clear and focused. It's got to be tentative. It's an observation, of course, but it's tentative. That means it's going to be proven or disproven and to be proven otherwise. So to reiterate it again, hypothesis is a hunch. You got this idea. Maybe this is not really true. Maybe if I double glove, that's not so important. I don't know. I'm not a surgeon. But it could be assumption, a suspicion, an assertion, or an idea about a phenomena and its relation or situation. The reality of the truth, you don't know. You don't know the truth. It's a guess. It's an educated guess. The above becomes the basis for an inquiry for a researcher. In most studies, they're possibly based on either previous studies or on your own experience or on someone else's observations. So the first thing when we talk about scholarly work is, oh, I got to go through the literature, and I'm going to go through here, and I got to find it, and I'm going to make, I'm going to try to come up with a very complex statement that is so complex, and it's going to eventually lead to the cure of cancer. We're not looking for that. We're looking for you sitting down and looking at your practice and saying, what is a myth? Is there something that I question? And then look into the literature and saying, is there stuff that backs this up? And if it doesn't back it up, that's scholarly work. We move forward with that. So again, a hypothesis has three characteristics. One characteristic, it's tentative. And we talked about that. And even if you have the hypothesis, and you have this written down in one statement, it's sitting in front of you, someone pulls an article, I say, well, no, it's already been done. Rearrange it. This is not poetry. When you write poetry, nobody should change your poetry. It's your thoughts, your feelings. This is not that. You can change these and make them different to try to find the place in the literature where it will fit. So the validity of this process or this proposition is completely unknown. Nobody knows whether it's true or false. That's why you're looking into it. In most cases, it specifies a relationship between two or more variables. But mostly two keep it simple. So here's the workshop. This is the fun part. And I'm going to have Pauline help me today. But we're going to divide into a couple of groups. So how many people do we have, Mike? 17. So if we can get it to five groups, so maybe five groups and just count off around. And I want you to send one representative over to Pauline to pick one item. And then we're going to develop a simple hypothesis on this one item. And you're going to write it on that big sheet of paper. Now, here's the thing about this hypothesis. So it's going to be silly. We don't really care what it is. But it has to be simple. It has to be an idea which you don't have any idea. And you're going to come up with ways to prove it or disprove it. OK? Bear with me. So let's divide up. What I want you to do is take time. And Pauline will give him a piece of paper and magic marker as well. I want you to look at this item. I want you to look at this silly, silly, silly item. I'm going to go with this one. And I want you to come up with one sentence. You're going to get some time. And you're going to come up with one sentence that you're going to try to figure out. Maybe like this one here, this might, this thing, this gun shoots only five feet. This could be, this thing could only fly two feet. It's a statement. This, I don't know what you're going to do with that. So I'm going to give you some time. I want you to kind of talk it over. I want a hypothesis, one simple sentence of trying to figure out something you don't know about this product. Please don't hesitate to open it up. Please open it up, however you want to do. You know, just don't aim in anybody's eyes. I want you to read your hypothesis to everybody. So we have the dart gun with the little suction darts. So our statement is that the darts have greatest adhesive strength to glass. Great question, right? It's not a question. It's right in there. We're asking exactly something we can test and prove. Group two, what's your question? How about the whoopee cushion? This is your next part. This is the next assignment. So we want to write three ways to investigate your hypothesis. So what that means is that you've all come up with a hypothesis. You've come up with this little introduction. And now you need to give me three ways that you're going to prove this. So one way is measures, those good measures. So how are you going to measure it? Another way is that we're going to collect the data. How are we going to collect it? And how are we going to analyze it? So usually that's like the three ways you can do it. One is tell me how you're going to do it. It's just one simple sentence. One, I'm going to do this. Number two, probably we'll use data analysis, collect the data this way. Number three, I will do statistical analysis, something like that. Understand that, all right? Three specific aims. So usually when you're writing these specific aims, they could be simply an experiment that you're planning to walk through. And why you want one, two, three, you have to lead them, one, two, three. I'm going to do this experiment. I'm going to have 20 people sit on that fart cushion. And I'm going to measure how many people laugh. Number two, I might take that and take that data to a statistician and get it analyzed. And then number three, I'm going to conclude with my data. Something like that, OK? Let's start working on it. You want to tell me, too, how many times you're going to do this. Yes, we're going to do a dozen in each group. That's good. We're going to drop the camp bomb from a height of one feet. So I need just one sentence. See, this is always the problem. We always strive to put too much information in. It's always that way. And you're writing these papers. I watch people write papers. There's so much more. Experiment over. Yeah, so they always put too much information in. And what it is is that you have to make it so simple that anybody can understand it. So you're going too far. And what your really hypothesis is is that how far will this thing go? And that's what you have to do. So I'm going to do this 20 or four times. I'm going to measure it. I'm going to analyze the data, number two, number three. And then I'm going to collect the data and then analyze the data. We're going to collect your data. Group one, I want you to remind us all of your hypothesis and tell us your specific aims. OK, so our hypothesis was we hypothesized that rubber darts have greatest adhesive strength to glass. Our aims were one, identify surface areas, surfaces by texture, two, shoot darts at surface, three, measure adhesive strength, four, analyze data. Do you see how straightforward that is? The first question they had or the first thing they had to prove was identify the surfaces that they're going to apply this experiment on. And then once they've identified that, then shoot them at them and then count and then analyze. This runs through everything. And what you're doing here, and there's an old axiom. Axiom, whenever you're writing grants or doing anything, tell them, tell them again, and tell them what you told them. So I'm having you repeat the hypothesis. That's always going to be how you're going to write a paper, abstract, or a grant. So you see, the simpler it is. So whenever you write these specific aims and you're writing on a grant, and we're writing sort of a grant, but I find grant writing is a great way of organizing your research. So whether you're going to write a grant or not, this is a great way of putting it all together, just doing what we're doing now. And key things, when you write specific aims, it's usually you have your hypothesis, you have your introduction, and then you have three specific aims, one, two, three, with a little short paragraph. So we'll give them just a little bit more detail of each one of those specific aims. And you notice that some of you guys have been putting a lot more data in there. You're going to say, well, I want to throw everything in. Make it very simple. That stuff, that other stuff, that goes to material methods. So the stuff that you're really excited about, that goes to material method. We'll talk about that in a bit. Next, materials and methods. So in your methods, you're going to take each one of your specific aims. And this is where you tell me how you do it. How am I going to do specific aims number one? Give me a little dirty details. How am I going to do one? How am I going to do two? Give me a short paragraph, two or three lines on each specific aim. Just tell me how you're going to do it. On your method of doing that specific aim, couple sentences. And then you're going to put them in one place, in maybe a soundproof room or a windless room. And you're going to shoot something like that. You see what I'm saying? So they need to know. And sometimes I say in painful detail of how you're going to. Because they're going to give you money on this. Set up outside of the cafeteria at Bedford Hospital. We're going to have coffee cards, free gift cards for all those who participate. And we're going to hand them out to each one. We're going to have them. It has to hurt when you're writing these things. And you have to take this reviewer. For the methods you mean? Yes. And you take each one of your specific aims. And you write one paragraph. You can have as many paragraphs as you want to explain. We can there. Good, good. OK. One, I want you to repeat your hypothesis. Tell me your specific aims. And give me your methods. OK. We hypothesize that the rubber darts have the greatest adhesive strength to glass. So we identified surface by texture. Shot the dart. We'll shoot the darts at a surface. Measure adhesive strength and analyze the data. So for our methods, we're going to go to Lowe's. We're going to buy a 12 by 12 tile of glass and ceramic. And then cut a piece of laminate and maple wood into 12 by 12's to standardize our surface area. We're going to assemble a tripod with our gun attached. Measured two feet from the vertical surface being analyzed. And three feet of height. It'll be indoors. Three darts will be shot at each surface. Using a digital hook weight scale, there is such a thing. It's on Amazon if you're interested. The adhesive strength of each dart to the specific surface will be measured. And then the average of the adhesive strength to each will be compared. Holy cow. Who said research was hard? The next part is preliminary data. So what I want you to do in the preliminary data aspect is to tell me what you know so far. And so this could be as easy as, you know, and you can either shoot this at a glass a couple of times, get a little bit of data on glass, or run a poll, grab a couple of people in a group, and you sit on it, see who laughs. It could be easily just doing some preliminary data. Very quick, very brief understanding of why you think your hypothesis is good. Get some preliminary data. Preliminary data means that you don't have enough data to make the conclusion or hypothesis. That's why you have a scent of what's going to happen. That's your preliminary data. So it's either stuff you did, and you could also say that you looked it up on PubMed in your smartphone and said, I found it in here. So these people already did this, and they didn't do enough of it. I'm going to do more. That's your preliminary data. So I just want you to sort of, I just want a short paragraph. Do a little quick experiment right now for about, I'll give you about five minutes. We're going to do a real quick, short experiment on your preliminary data, and then we'll come up with it. So it's one paragraph. Group one, let's repeat your hypothesis. Let's go through it again. OK. So we hypothesize that rubber darts have greatest adhesive strength to glass. So this is an Army Command dart shot with five rubber darts. Our preliminary data show that there was greatest adhesive strength to laminate. Wheat cushions make people laugh. These man-made flatulence displaces are used to produce laughter. We hypothesize that the majority of individuals would laugh when the wheat cushion went in. And so again, it's preliminary data. So instead of supporting, saying that we aim to continue these experiments on to gather more data to prove or disprove our hypothesis. But you can say in our preliminary data supports further work on our hypothesis. Very good. Great job. So last, conclusions. I need three sentences. Do you remember how I told you? Tell them. Tell them again. Tell them what you told them. I need three sentences. Maybe one sentence describing the object again. Number two, a sentence on your preliminary data. Number three, our hypothesis. And we plan, we aim to prove or disprove our hypothesis. OK, let's get to work. Conclusion. We set out to establish our hypothesis that three feet is needed to successfully deploy a cap on the cap bomb with 100% efficacy. Preliminary data would support this hypothesis. Although we did find that the cap on the cap bomb did deploy at lesser heights, not with 100% efficacy. Further investigation will be required on the efficacy of happiness with the six decade children. Right, exactly. And somewhere in there, you have to say we aim to prove or disapprove our hypothesis with future studies. Because we have to really still continue to make the mystery. Done. You all need a great round of applause. What great work. What great work. Let me tell you, there's a guy, and I don't remember. He was a general during World War II, Patton. And Patton's statement was, hold him by the nose and kick him in the ass. And what I like to say is tell him, tell him again, tell him what you told him. If you learned anything from tonight, you've learned that you've repeated it multiple times. Unbelievably, they want to hear it. So what did we do tonight? What did we do tonight? You have just created a large part of your IRB, large part of a grant, and the start of scholarly work. Look at what you did. For a grant, it's one page. You turn that into one page, that's a grant. And you turn that into one page, and that's your IRB, which we will be doing. So we want the momentum, the intense and consistent courage to drive our scholarly activity. We want to accumulate abstracts, posters, manuscripts to strengthen our programs. And we have a rotation of crews to establish a critical core of mentors. That means I taught you, you'll teach them. They'll teach others, and they'll keep going. You got homework. I hope you all stay with me. Develop one sentence hypothesis on what you do in your office. We're going to investigate a myth of medicine. We're going to investigate EMR. We'll investigate quality changes in the office. No case reports yet. I don't care if it's the simplest thing in the world. That's scholarly. Don't make it complicated. Make it as easy as possible. We're making these steps. And again, repetition after repetition solves the issues. Any questions?

Scholar 7

medical practice

scholarly project

workshops

research skills

academic outputs

mentorship