So, just to remember what we did at the last session, we started with the fun item, we started with the whoopee cushion, we developed a hypothesis about that cushion. So what was our hypothesis for the whoopee cushion? If it made people laugh. Yeah. So if you sat on it, how many people would laugh at the noise? So from that, you know, developed an introduction, so a three-sentence introduction. And after that, we did a little experiment to see how we make that hypothesis prove or disprove that hypothesis. And then we developed some preliminary data, and then developed material methods, and we developed a conclusion. And at the end of this short session, you know, what we essentially did is we had a grant, and we had things written out, and it was really very nice to see that that movement went forward. So what will we do today? Well, we reviewed a little bit. We're going to review a little bit more about the aspects that we're going to do, but today, we're going to repeat with your homework hypothesis. We left you last week, last month, with the development of this hypothesis. So and I've gone to each one of your tables, some of you have it, and then others. We're just going to develop today and go through it, and I think this is one of the more important steps is that creating that statement that really explores the literature and puts something new out there. This is a really important step, and it can be relatively painful as you go through it, and then you get the literature, and you look through the literature and find that maybe I have to change my hypothesis just a little bit so I can put it in that hole that's missing in the literature. So being scholarly, it's having or showing knowledge, learning, or devotion to academic pursuits. And I think we can all do that. That's an agreed statement. Scholarly topics, it doesn't matter. Really, you know, when I teach residents or fellows, whether it's a case report or whether it's an IRB project or it's a larger project, the process is about the same. It's very repetitive, and the more you do it, the better you get at it. And the topics are just to get started, get something, get a topic, get moving through it. But once you start it, you go through the process, you learn. You go through the process again, you refine it, and you learn, and then pretty soon you can do it anytime and anywhere. But the process is important. We just went through it. It's the development of the hypothesis, the methods, the preliminary data, the results, development of an abstract, development of a poster, development of a manuscript. So the intensity is it's a serious concern to be scholarly, it's a team concept to move the project forward weekly. You try to meet weekly. Once we have this done, I think it's important for you afterwards to meet weekly to discuss with people that are going to be working with you. So very important. So an objective is, again, it's to develop the hypothesis, to create a smooth hypothesis, to develop your preliminary data from there and your specific aims and your methods, your results. And then eventually what we're going to look at tonight is where do we send it to? So do we develop an abstract from that? Do we develop a manuscript from that? And it's all doable. It can all be done. So just moving forward in your scholarly pursuits. Maintain a serious approach throughout the year. So start the project, continue it out. Weekly team research meetings, quarterly research review meetings with attendings and in the DME, internal presentations of your research. You'll see me as tonight going through, I'll be coming through and I'll be asking you to say your hypothesis and give us what you've got and how things go so you can all sort of benefit from the presentation and development of that process. And celebrate scholarly activity. So courage, it will force you to shatter your perceived limitations. You know, you shouldn't feel that as a clinician you're limited to just what we do. You are a scholar and you can do that. You can move forward and do the work. So it makes you reach for meetings, that maybe to submit your material to meetings. It makes you reach for journals that you might not think you could be submitting for. But being realistic, but then moving forward and gives you some courage there. It will give you a perspective. You know, research is about a simple hypothesis. Research is about, to my mind, it's simplicity. And we talked about before, it's not a complicated statement. It's not something that has algorithm after algorithm after algorithm. The best research I've seen is that one statement, whether it's proved or disproved, and move forward, you keep things very simple. And it's not hard. I think that the one thing that, you know, I've learned throughout the years is once you know the roadmap, it isn't that hard. It can be done. It's tedious. It's painful, like the internal medicine resident told me today. This is painful. Yes, it is. It's tedious. It will provide memories of good and bad. It will fuel your future endeavors. And what's the bulk of what you do, say, if you're at ER? You're looking at what you do more commonly, what you do if you're in orthopedics and topics that you're very familiar with. But one source is electronic medical records. It's a huge data reservoir. We use this almost all the time in allergy immunology. We look back at things that we've done or things that were myths that we keep in our practice because someone else told us that was the right thing to do, but there's no literature on it. That's great. We do. We used to, there was this one item that we're having a little difficulty when we're working is that whenever we give allergy shots, if we have a large local reaction, you know, we'll take the syringe and pull up epinephrine in it and squirt it out and then pull up the allergen and then inject the allergen because, you know, in our minds, that was just passed on. We thought there was tons of information about that rinse effect, and you look at it, there's no information at all. It was something we passed on and passed on, so no documentation, but it would be a great place to start in this scholarly work in your clinical area. So it's a source of one type in this research, and it's a great place to start to unravel a myth. So large practices, if you're blessed with a large practice, you can have outpatient, inpatient research, sites for case presentations, quality improvement studies are good scholarly work. Again, IRB approval for everything, quality improvement studies. You know, you walk around and you hear these things that are pearls. People tell you a pearl, and, you know, so that might be something you could research into. Your attending says, well, here's this pearl. Don't forget it. Well, look it up. It might be something you've been researching. It's just something we passed on from attending to resident and et cetera. So sources of research data, use your EMR. Quality improvement studies, you know, these are needed in your ACGME program, so you need that type of process where you're constantly improving the care that you're giving. So these scholarly improvements can be scholarly work. So it's an intent to improve the quality of particular medical services. It can be done within a private practice or a larger institution, but review it with the IRB as well and make sure you submit more important. So osteopathic focus research, that can be done, you know, you're going to need a mentor, an OMT, someone who does OMT. You can do LICH search. If you look at a lot of LICH research, the thing about OMT is it's almost like those pearls. They're handed down, handed down, but are they really documented? Do we really have good literature behind it? And that's where your scholarly work can come into play. Types of work, so you can develop an OMT module for your specialty, or you can do OMT on various disease processes, and one of them for us is like in allergy. If you look at somatic lesions in asthma and you kind of go to foundations and you look through foundations and you say, and we all believe, you know, it's a T4, 5, 6, and 7. Okay, those are where the somatic lesions would be on the left, and we hear that, we hear that, but then we go to the foundation, and we think it's well-documented, and we go to the textbook and we look in there, and you go back to references, and it's a casual conversation where it's really not documented. So what we're doing now in our practice is then documenting asthma somatic lesions. So there's a lot out there we can do with OMT and osteopathic care. So your timetable, so while we're doing this, you want to judge your time, and we'll be looking at that as well. You want a good case report, and case reports are scholarly work, too. In fact, I like to motivate people by doing scholarly work. If you look at PubMed, PubMed Me, you'll see a bunch of case presentations. I use that as the bait, you know, I throw that in. You get someone published, they get excited and they want to move on, so it's a way you mentor people, get the case reports. But the real thing about case reports are they're quick turnarounds. They still count as scholarly work, they're still going to count on your ACGME forms, but getting those in as abstracts and getting posters and getting papers out, I use that as bait. You know, I get somebody that, like a resident who's interested in allergy immunology, I'll throw them a case report, and if they can write that up, and they can turn it around two weeks, that's a good candidate for me. So we draw, you can do that, but it still counts, and those are quick turnarounds. You can publish those very easily. EMR and quality improvement studies, those are several months, it's going to take a whole year, so gauge how you're going to do it, especially if you're doing, especially with IRB approval. So nearly impossible to do bench work, don't even think that this is bench work. People perceive scholarly work as that's all scholarly work can be, is bench, and that's not true. There's other things we can be doing, so link studies, so whenever you're doing something, link it to other people. Now, for the last time, we talked about the development of your project, I asked you to bring a champion. So I see a lot of champions, so we brought some champions in, because you want to link your project with other people. You want to link your project with a fellow, a resident, and a student. You want to have a lot of people sort of experiencing the effect. You want to have everybody come in to feel the way it works, and then you get as many people as you can involved. All right, so this is the fun part, so this is hypothesis development. So definition, hypothesis, it's a tentative explanation of an observation. It's a phenomena, or a scientific problem that can be tested by further investigations from American Heritage Dictionary. So it's an observation. We all make observations every day, I mean, in your clinical practice. Does it work, does it doesn't work, and you try to make a statement about it. It's a phenomena. Something occurs, something heals faster than before, it's a phenomena, and it has to be unanswered and testable. So the key terms about hypothesis is that it's a statement, it's not a question. If those of you brought examples today and it's a question, change it to a statement. It's not a question. It's got to be clear, it's got to be focused, and it's got to be simple. Don't use a lot of words, make it tight. The painful part of it was making it tight, get rid of excessive words, and making it look as if someone else read it, and say, yeah, I got it. So it's got to be very simple, and everything else flows from that, and you have to remind people every time what you're doing. So it's, again, it's an observation, and it has to be tentative. Someone said, oh, why are you cutting that out? I like that sentence, and I said, you're not married to it. So don't marry to it. You are not even dating it. You are not even having a lunch. You're not married to it. And the reason why I say it's tentative is that you may look at it, and I don't know how many times we went through that, but you might look at it and say, you know what, someone already did that. All right, what didn't they do? And let's try to remodel that hypothesis so that we can move forward. So then it's to be proven. So it's never been proven. So how am I going to prove it? So how am I going to do it? And that's your specific aims. That comes after that. So how am I going to say the sentence, and then how am I going to figure it out with three simple ways? It's got to be very simple. Things come in threes, three sentences, three specific aims. Everything comes that way, and once you can start thinking that way and start thinking in simplicity, this all gets easier. If all of a sudden it's like your family tree gets branched, once it starts branching, it becomes too complicated for the setting we're going to do and the number of years or how many years you want to do it. So if it's just a simple branch, a straightforward shot, it's going to be better off and easier to do during this process. So it's a hunch. So you might have a hunch about something. It might be something that, and we'll talk about the hunch in a minute, about an assumption, a suspicion, an assertion, or an idea about a phenomenon, or it's a relationship, or a situation. The reliability and the truth is unknown to you. The above becomes the basis of inquiry for your research. So getting a good sentence based in the literature is going to be the most important thing we do tonight. And then in most studies, they're possibly based on either previous studies or on your own or on someone else's observation. So you may come up and you may look at it and say, you know what, every time I touch this thing and I put this powder soap on my hands and I wipe off before I go in a room, less things happen to the wound. I mean, it's that simple. So you may want to make that kind of statement. So again, there's three main characteristics, and it's tentative. So it has to be, if it was certain, it doesn't make good research. If it was a certain statement, everybody knows about it and it's not worth publishing. But it's got to be tentative. And its validity has to be unknown. And in most cases, it specifies a relationship between two or more variables and just stick to two variables. All right, here we go. And we're going to try to get it through. So what we're going to do is we're going to get some paper, and everybody's going to get some sticky paper with a magic marker, and we're going to talk about your hypothesis. And I just want you to write it down. I'm going to come and work with you and try to make it as simple. You can go ahead and get online if you want, but let's try to get the sentence first on something that's a guess or tentative, and we all gave those sort of homework. So let's try working on it. Pauline, you want to go ahead and hand out some paper and some markers? You could do that. Or whatever you have access to. It doesn't have to be at a marathon. It could just be athletes in your office, you know, someone, and you'd have to have inclusion criteria and exclusion criteria. So this age range, males, females, that's really, really good. Take a side on either. Your observation, what is your observation? That it does. Okay. So then that's how you have to look at it. Okay. So take it from there. So you've seen it, you've heard it, now is that true? I'm trying to decide what to use here, because we could use symptoms, and we're already thinking like smokers. That's a secondary endpoint. So your primary endpoint would be trigeminal nerve stimulation compares to flownase. Clean that up a little bit. I think the statement is that this is true. So what is your observation? So one of you has seen it. My hypothesis is that maternal shoe size less than six results in an increased primary cesarean section rate in pregnant women. So have you observed that? Observationally over the last 30 years, it seems to be the case. Okay. Great. So that's a great hypothesis. You observed it. It's not been published before. No one's published it. That's an easy, it's two variables, shoe size. Shoe size and whether they had a cesarean. Decreases the likelihood, which is intuitive. Yeah, that's intuitive. And in our hospital, we have an issue with that. Yeah. You know, we have high rates of patients. So it's a big population for you, and so it's easy, accessible to you. Right. So give me that in one sentence. It's based on an observation. So you all made those observations? Okay. And you see that population, that happens enough that you can study that? I believe we can. It's a big enough population, and is there a question within that? we're going to be reading hypothesis in a couple minutes so you'll get an idea. And just pull that out. Simple. Make it simple. Don't make it complicated. What you're talking about is real complicated, and it's deep into the literature, and you're going to have to reach in different places to get it. Make it as if you're reaching for it in your office, like it's on your desk in your office. It's got to be that common. Okay, so those are your two variables that you're going to compare. Do you see a lot of those? I mean, is this part of your practice or what you see routinely? Is there enough? So there's enough of those. Lots of those. Those things are good, but we need to have a hook. And that's a great – I like it. So let's write that down. So what I'm going to do is – just so we can all get the feeling, and I kind of walked through. You guys are doing great. These are all great ideas. What I want to do is I want to walk through, and I want people just to read their hypothesis so we all get that idea of where we're headed. You're all in the same range, okay? We're all doing great. So I'm going to start with Gabby here. So, Gabby, could you read your hypothesis for everyone? Patients that participate in a formal diabetic education program have better people who have an A1C level than those patients who do not participate. Very simple. The idea is that they have a population, so there's enough of them to study within. So you have this group, and there's two variables. Gabby, your two variables? The A1C level. And the education. And the education. So you have two variables. Very good. We hypothesize that inhaled corticosteroids, in addition to a short course of oral corticosteroids upon discharge, reduces 30-day remission rates for asthma relapse in a community-based hospital population in the United States. Tell me why we looked at, and you put that statement, that word, in the United States. Because most of the majority of the research, actually all the research and recommendations that are made today that we follow in the United States are based on research done in Europe and Canada. Nothing has been really done in the United States, yet we follow this. And then why did you say community-based? Because they're done in big tertiary centers. Tertiary care centers. In Europe. Yep. And so there really isn't any study showing that, and so if you look and you dissect that, the genetics are different in any part of the world in how people handle asthma, and the culture aspect. So what you did was, you did this literature search, and how many times did we have to revise that hypothesis? Too many to count. Too many times. So we revised, revised, until we hit some place that there was a hole, that this little square peg fit, and it fit, and then we wrote it up. So, good. Let me, give me yours. Lidescope intubation is superior to direct laryngoscopy in patients with head and or neck trauma. Good. So you do that because you see that a lot. So it's a big population. You do that. You can get the numbers, and your observation is, what's your observation? Is this true? It's tentative, but it's not been proven, and it's tentative, but your observation. So that's how you write your hypothesis, from an observation. Even if you think it's true, it's not been published true. There's a difference. Maternal shoe size less than six, measured in the first trimester of pregnancy, is associated with a higher rate of cesarean delivery. How? Shoe size. So tell them how you came up. Tell them. Well, I'm an obstetrician, and over the last 28 to 30 years, many of my patients who have ended up with cesarean sections, because of problems with the fetus not fitting, have been smaller in the pelvis, but also small in the foot. And just by asking patients offhandedly, what's your shoe size? I found that many women who have a shoe size that was less than six, ended up in that category of those who are having cesarean sections. What an observation. What an observation. You see, that's all it takes. That's all it takes. And you know what? If I was an editor, I'd take that article. That's great. And obviously, you have enough of these in your practice, and enough of things, and it's your observation that that is a true or false statement. It's a true statement, but not yet published. Great. Patients that really are pushing you towards this. It's tentative, and you have the population, so you have all the captive audience that have to do these research projects. So that's great. This is really good. So you all have some great ideas, and these are hypotheses. Now, again, you're not married to them. You're not dating them. It's not even a casual handshake. You just met them. So what I want you to do is take a couple minutes, and this is called schmoozing. This is called ironing. This is what we do to make this just a little bit touch. I want you to launch your computers. I want you to go to your browser, go to the Wi-Fi, go to PubMed, and then I want you to look at this. I want you to look to see what's been published, if it has been. Okay, and if there's something, and I want you to read that abstract, or whatever it is, and Pauline, I need you to give out some cards. You'll get three cards, and three cards, and I need three references. So if it is suitable, if it's good, nobody else has done it, and again, schmooze it a little bit. If someone else has done it, what can you do a little different? Is it a tertiary care center? Is it an outpatient? Is it an inpatient? Is it out of the United States? Is it in the United States? What makes this different, and how can we make the hypothesis a little bit different? So I need three, three references. One, a general statement. One, something that supports the general topic, maybe like concussions. You know, concussions are causing this and this and this. Number two, what supports part of your hypothesis, and number three, what really pulls it in. So I need three, and this goes to your introduction. So we need three references that walks me through to ends in your hypothesis. A general one, another closer to your hypothesis, and another one that kind of supports the hypothesis, and then, boom, your hypothesis. So I need three references. So right now, just worry about schmoozing out your hypothesis. See if it's ever been done before, if anything's done close to it, or can we change your hypothesis to make it, it has a hook. I like to say it's a hook. The hook, or it's that square peg that you're walking through, and, oh, it fits in there. How are we all doing? Is everybody in there where we've gotten sort of a little comfortable with your hypothesis? So based on, so we had your original hypothesis. All right, so your original one, that came around, and then we did the literature search. How many of you had to change it, even small? You guys, you guys? All right, so I'm going to go around again. So I'm going to go to those that changed it. So Gabby, can you tell me what your original hypothesis was and what you changed it to? Patients that participate in a formal diabetic education program, we had to define what type of education program. Was it a group class, individual sessions with the dietician? We haven't decided officially which type of intervention, so we're going to continue to work on that, make it more focused. But most of the literature that I found was outside the U.S. China, Japan, Australia, and Canada. So what are you going to put in your hypothesis? We're going to add in the U.S. Yeah, that's terrific. So based on what you found in your literature, and this is just sort of a superficial level that you're going to go deeper on, because that's where we're going to head at the next session, but you're going to go a little deeper on, and you're going to schmooze that to make that fit. So you reviewed your abstract. So we looked for the fit for your hypothesis. You adjusted your hypothesis to fit the hole in the literature, right? You all kind of schmoozed to change it to make it work, or you created a whole new hypothesis. No one did, so that's really good because you know your literature. So you didn't have to redo it. You adjusted it, and that's perfectly legal to do. No one's going to come and arrest you. So we did that. So you also got three cards, and we did a little bit of a lit review, and you found those references, so you should have had at least three references. So what I want you to kind of do now, and I know you've done a little bit already, but you need to look at your topic, and you need to look at it from a general, so you need to step away from it and look at it from a general reference that you could say your first sentence to introduce the reader or the grant reviewer to your topic. So it might be something on medical education in general as a difficult topic or whatever, and you get a reference for that. So how to measure the outcomes are difficult, and here's a reference for that. So that's your first, and then your second and third reference, each a sentence, and each one of those lead. Like you all have had parts and pieces that got you there, like syphilis, you've seen the testing for it, so that might be your third reference in saying it's been looked before, but not in a community setting. And then your last sentence is we hypothesize that, or we aim to look at that, and with your hypothesis. So what you're doing now is that's the construction of your introduction. So as we go, trust me, is that we develop this. You will now, as we did with the whoopee cushion and we did everything, you will have at the end of this session, you should have your hypothesis, an introduction, a specific aims, preliminary data, then materials and methods, a conclusion, and then you're done. That document, we're aiming to complete that document, and that document then you will cut and paste on the sixth session into your IRB application, and you're going to submit that, and we're all going to schmooze that on your seventh, and then you're going to start your research. So that's where we're headed. Right now what I want you to do is I need you to write an introduction, three to four sentences, no more. Lead me through it, walk me through it, tell me where the hook's at. Okay? Get to work. All right, do we all have our sentences? Sentences, sentences, everybody's good. Everybody's nodding, nodding, nodding, good, okay, and not sleeping. All right, so I'm going to, so here comes your big performance. So you're going to have one person come up here, stand on this X, and you're going to read your introduction. As the prevalence of type 2 diabetes continues to grow in the United States, so do the costs of providing medical care. Studies have shown many types of formal diabetic education improves hemoglobin A1C levels and outcomes. However, the majority of these studies on diabetic education and A1C outcomes have been done outside the United States. We hypothesize that diabetics that participate in a two-hour diabetic boot camp program will have a better A1C level than those who do not. Terrific, thank you, Gabby. You're welcome. So you see how she changed that? Outside the United States, that's tremendous. That's going to make a great paper. Direct laryngoscopy has been the gold standard for tracheal intubation in emergency and trauma patients. Studies in level 1 academic centers have shown that immobilization of the C-spine worsens tracheal intubation conditions, and that easily determined anthropometric measurements may be able to predict obstetric outcome in labor. Several studies have looked at measurements such as shoe size, maternal height, and fundal height, but have not been able to arrive at a suitable measurement that can predict caesarean delivery. 1C techniques have been shown in the past to reduce patient symptom scores. We aim to show that osteopathic manipulation to the trigeminal nerve will provide symptomatic relief for viral URI, allergic rhinitis, and acute sinusitis. Wonderful. Today, a conundrum exists in defining the etiology of idiopathic rotator cuff tears in the younger population. There's a significant amount of anecdotal evidence that suggests sleeping positions contribute to shoulder pain. Clement et al. has shown that subacromial pressures vary with simulated sleeping positions. We aim to show that sleeping positions contribute to the development of rotator cuff tears. Wonderful. There's the general perception that routine exercise is good for the immune system, but how much is too much? Several previous studies have documented decreased neutrophils, T cells, and immunoglobulins in elite athletes. We propose that performing aerobic exercise more than 150 minutes per week increases a subject's annual URI rate. The goal of our research is to create an exercise prescription to optimize healthy workout regimens. Scholarly activity is a requirement of all Council of Podiatric Medical Education training programs. The literature suggests that educational initiatives to promote scholarly activity in other health care disciplines have been successful. It is our belief that podiatric residents participating in an annual research symposium will lead to a more successful academic career. Wonderful. Wow, you've just taken a quantum leap for the entire institution. Everybody's just become scholarly. And I can tell you, this is the first time I've ever led this big of a group, so I'm very proud of you. I'm very proud that you did this. And when you came up here, you sounded so good. I don't think you had the idea that this is what you were going to be doing, but you sounded terrific. You sounded like any academic institution I've ever been at. It's tremendous. So does anybody know who this is? Patton. Patton, thank you. So here's what Patton once said. Patton said, hold them by the nose and kick them in the ass. Can you picture that? Now, here's what I mean when I'm writing this paper, is tell them what you want to tell them, make sure they know what you told them, and tell them again. And that's how this one, and when we come out of this whole thing, it's going to be surprisingly maybe one or two pages. And you're going to repeat, you're going to do this every time through the introduction, through the specific aims, through the preliminary data, through the methods, and then finally to the conclusion. And it sounds like it's redundant, but it will sound really good at the end. Okay, so I want you to go ahead and just remember that statement. So for the next, your homework to go home on, and what we're going to do, I think it's February 15th, when we re-meet again, and we're going to work on specific aims. Now, I only need three specific aims, and the third one ends with your hypothesis. All right? So you tell them again, right? So I need three aims that build on each other, short paragraphs under each aim. So I want one or two sentences, maybe three sentences under each specific aim, giving me a little bit of detail, not everything, just a little bit, because you're going to tell me more about that detail in your material methods. All I need to know is how you're going to do it. So for example, so you would say, number one, identify the population I'm going to look at. Here's how I'm going to do it. I'm going to look at this hospital and these individuals. Number two, I am going to recruit a statistician who's going to tell me how many people I need. Number three, I'm going to analyze the data, and I hope to prove my hypothesis, or this. So those are three specific aims. Very simple. Don't make it complicated. Get one piece of data out of each. All right? And then we'll go ahead, and we'll talk about material methods. So what I want you to do is construct this on a Word document. I need you to put your hypothesis, your introduction, your specific aims. I want you to keep one Word document that has this all in line and your references. So at any one point, we can pull it up and add to it. So at the end of the day, the document's going to be about two, three, four pages long, and we're going to move forward with it. Does that all make sense? Really, thank you very much. You're making me very proud. Thank you.

hypothesis formulation

research process

literature review

scholarly writing

research proposal

teamwork

iterative process