Less than 8% of orthopaedic research originates in low and middle income countries (LMICs), despite the fact that 95% of deaths from road traffic accidents occur in these countries. Global partners of the Institute for Global Orthopaedics and Traumatology (IGOT) have asked for assistance in building the capacity to perform clinical research. This is important because:
- Research fuels advocacy, drives policy decisions and guides the allocation of resources in medicine.
- The orthopaedic surgeons who address the burden of musculoskeletal disease in LMICs struggle with a lack of research resources, literature irrelevant to their practice and professional isolation.
- Researchers in resource-poor settings are essential partners to UCSF's goal to 'promote health worldwide'.
This project will address these issues on three fronts:
- Design a digital toolkit of research resources leveraging existing resources such as CTSI’s online research tools, the Department of Orthopaedic Surgery’s Research Bootcamp, and EpiInfo 7.
- Select a platform that will function using the most commonly available technological resources, and integrate mentoring and support between experts and learners.
- Evaluate program effectiveness and sustainability based on partner feedback and marginal costs, respectively. This evaluation will help to guide content, platform and operational improvements, before the project is made widely available in other settings (other LMIC partners as well as resource-poor and isolated locations in the U.S.).
Our goal in creating this toolkit is to build the ability of trainees and surgeons anywhere to plan, implement and publish relevant research. We are piloting this program in the most resource-constrained environments in order to allow future scaling of the toolkit in sites that have access to more resources. Our long-term goal is to establish a generalizable suite of tools akin to the resources available for students through the Khan Academy or MIT OpenCourseWare.
IGOT has completed interviews that explore the barriers to research in LMICs, and has used the subsequent analysis to tailor content that addresses these barriers. IGOT has also completed research related to the optimal format for content delivery in LMICs. These initial steps lay the foundation to start work immediately on content and platform development.
- Select a format for content delivery based on available technologies that provides access to the widest range of users.
- Prove content validity of the toolkit’s curriculum through consultation with expert clinical researchers in orthopaedic surgery and with academic orthopaedic surgeons in LMICs (modified Delphi analysis).
- Create simple web-based tools such as webcasts or podcasts for each of the topics, a research question formulation tool and templates for creating proposals and budgets that will live on the IGOT website (www.globalorthopaedics.org).
- Create a research proposal forum that allows posting, feedback and partnering on projects.
- Pilot the toolkit in Lahore, Pakistan and Kathmandu, Nepal.
- Iterate the program based on feedback from the charter sites for future program expansion.
- Determine the overall program cost and marginal site cost to determine the expected return-on-investment of the program in the future.
- Improvement of methodological quality of thesis proposals after program participation based on the Journal of Bone and Joint Surgery (American) levels of evidence (http://www.jbjs.org/public/instructionsauthors.aspx#LevelsEvidence) based on an analysis of current and 2013 resident thesis projects
- Website Analytics
- New and Repeat Page Views
- Length of View
- Use of Toolkit – mandatory at sites after first class with resident and faculty champion established at each site.
- User Satisfaction – Participants average satisfaction 75% based on post-program survey
- Research proposals entered into global orthopaedic trial registry by each pilot site
- Secure one pilot site in the Bay Area for implementation in the second year of the program
Cost and Justification
Estimated cost $45,000 composed of labor to analyze data held at the Institute for Global Orthopaedics and Traumatology (20%) as well as content generation and web development for the toolkit (76%) and project management (4%). One of this project’s strengths is that it leverages existing content and will utilize a cost-effective digital delivery method. This will allow the program to become sustainable and have a lasting impact after the initial investment in the program.
Syed Mohammed Awais (Dean, King Edward Medical School and Mayo Hospital, Lahore, Pakistan), Ashok Banskota (Founder/Surgeon Rehabilitation Centre for Disabled Children, Kathmandu, Nepal), Amber Caldwell (Director of Development, IGOT, UCSF), John Collins (Educational Studies, University of British Columbia), Richard Coughlin (Founder/Director, IGOT, UCSF), Richard Gosselin (Co-Founder/Co-Director, IGOT, UCSF), Harry Jergesen (Co-Founder/Co-Director, IGOT, UCSF), Saam Morshed (Clinical Trialist/Orthopaedic Surgeon, UCSF), Theodore Miclau III (President Orthopaedic Research Society/Founder and Director Orthopaedic Trauma Institute), Aenor Sawyer (Paediatric Orthopaedic Surgeon), Daniel Sonshine (IGOT research Fellow), Paul Tannenbaum (Web Developer, IGOT, UCSF), Angelique Slade Shantz (Project Manager, Orthopaedic Trauma Institute, UCSF)
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