CTSI Annual Pilot Awards to Improve the Conduct of Research

An Open Proposal Opportunity

A Clinical Research Toolkit for Surgeons in Low Resource Environments

Proposal Status: 


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.


Project Plan

  1. Select a format for content delivery based on available technologies that provides access to the widest range of users.
  2. 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).
  3. 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).
  4. Create a research proposal forum that allows posting, feedback and partnering on projects.
  5. Pilot the toolkit in Lahore, Pakistan and Kathmandu, Nepal.
  6. Iterate the program based on feedback from the charter sites for future program expansion.
  7. Determine the overall program cost and marginal site cost to determine the expected return-on-investment of the program in the future.

Success Metrics

  • 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)


Jesse, I think there is great potential for this project to assist with needed clinical research in rural and low income clinics in the US, as well as in developing countries. Piloting it in the challenging locations you have selected will insure the development of an investigative mechanism that will work well in a wide variety of settings.

Thanks for the suggestion Aenor. We have the goal of creating something that is relevant to those interested in using and producing research anywhere in the world. The toolkit won't compromise on rigor, but will try to identify ways that low-resource settings in both the developing world and in North America can still ask and answer relevant clinical questions. We added the goal of identifying a Bay Area partner within the first year to the metrics of success to reflect our hope to make our project more generalizable.

Overall, is an important project. The forum specifically designed to facilitate collaboration and to be a space where researchers can share experiences, ask questions and expect to find some technical answers is interesting and certainly in line with what visiting surgeons have requested. I imagine that this toolkit & portal could serve as a remote mentorship device in a mini-grant program to novice researchers amongst IGOT's global partners. I am curious regarding how the compilation of resources would be maintained and monitored? Who will respond to questions directed at IGOT or OTI?

Yes, we are aiming to create a place where people connect and learn from one-another. In this first iteration there will be a capacity-building focus. Our partners have expressed a need for learning modules for their centers (developing world academic orthopaedic surgery programs). The toolkit is intended to make the IGOT website a 'go-to' place for surgeons wanting to learn more about research methodology. After the training program is established and we have a cohort of graduates we plan on transitioning our focus towards enabling collaboration between researchers. The success of the toolkit will provide us with the credibility to fund that expansion of our scope. I think that second phase would be the perfect environment for the 'micro-grant' program. We know how little it would cost to hire research coordinators for our partners based on a survey we just completed. We already have plans to develop an 'angel network' of donors to support the program. As far as responding to questions from participants, we have built mentoring into our proposed toolkit. We have 7 collaborators with significant research experience ready to act as mentors. We are going to try and make that relationship real-time through Skype video calls with email and blogs as back-up. As the program expands we will add more mentors outside UCSF, potentially even 'graduates of the program who want to 'give back'.

It's exciting to see a proposal that links orthopedic research and global health. The lack of trauma transport and services at medical centers is a substantial problem and this proposal attemts to address it from an educational perspective. It is already strong but could be better linked with the increasing distance learning projects in CTSI. The GHP has focused to begin on research administrative staff but other projects involving research training (Jeff Martin) could be used in this project. Also, the CTSI GHP is closely related to UCSF GHS which should also be receptive as it develops more educational programs. Does general surgery have projects that could be linked? They'd be helpful I'd expect in trainings in the soft tissue injuries that occur along with bone injuries in traffic trauma.

Thanks for your comments Paul. I have contacted Jeff Martin and we have started to figure out how best to leverage the existing content and tools available through CTSI/TICR. There was a thought that our mentors could lead virtual small group sessions within the curriculum of TICR to specifically address barriers faced by low-resource sites. I have also discussed this idea with Jaime Sepulveda of Global Health Sciences, and he is looking at our proposal. I also contacted one of our collaborators in general surgery, Rochelle Dicker, who is interested in Global Health. She has assured me that there would be interest and support in the creation of the toolkit.

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