“We live in an era of specialization, but specialization can be overdone and there is no inherent reason why the qualities of investigator, teacher, and practitioner should not go hand in hand, be represented in a single individual, and…be none the worse for the mixture.”
Harvey Cushing, MD, addressed these words to graduating students of Jefferson Medical College, Philadelphia, in 1926. In the intervening 70-plus years, the neurosurgery specialty has tended more and more toward subspecialization, a trend driven in large part by technological advances that continually increase the level of complexity of everyday practice.
In this climate, some understandably have come to view research that impacts the practice of neurosurgery as the realm of academicians specializing in clinical research. Others continue to see value in all neurosurgeons’ continued participation, regardless of a particular neurosurgeon’s practice type.
One such neurosurgeon, William H. Brooks, MD, discusses his experience with facilitating community-based, patient-oriented clinical research. “Becoming an active member of a community-based trial renews the dedication to clinical research that is a tradition of neurosurgery,” he writes in this issue of the Bulletin.
Dr. Brooks moves beyond the idea of neurosurgery’s tradition with the view that “The common ground for patient-oriented community research is the community at large, where basic and translational research can be melded and evaluated as potentially therapeutically effective.”
This idea also underlies Translating Research Into Practice (TRIP), a two-stage initiative of the Agency for Healthcare Research and Quality. TRIP II, funded in 2000, “focuses on implementation techniques and factors associated with successfully translating research findings into diverse applied settings.” The TRIP initiative was conceived in response to a “gap between knowledge and practice” such that “up to two decades may pass before the findings of original research become part of routine clinical practice.”
This issue of the Bulletin seeks to explore how neurosurgeons bridge “the gap” between research findings and clinical practice, as well as other matters related to research and practice. The Bulletin asked several neurosurgeons to contribute their experiences and viewpoints, resulting in an issue that offers a glimpse into how neurosurgeons view clinical research, how they are incorporating it into their practices, and what some of their concerns are with regard to study design and methodology.
This collage of neurosurgeons’ ideas and experiences includes an article by Paul McCormick, MD, that explains why neurosurgery has taken issue with the Spine Patient Outcomes Research Trial (SPORT) and introduces the Stenosis Outcome Study (SOS). In addition, the development process of a new study, the North American Trial for Unruptured and Ruptured Aneurysms (NATURE), is described an article by principal investigators Adnan I. Qureshi, MD, and L.N. Hopkins, MD.
Brett A. Scott, MD, illustrates how he incorporates research into his private practice using resources like peer-reviewed journals, annual meetings and courses. Robert E. Harbaugh, MD, and Richard E. Glicklich, MD, discuss how AANS paves the way for neurosurgeons to participate in research studies in an interview on the AANS Neuro-KnowledgeTM program. The question of funding is touched upon in an article describing AANS’ avenues of support for clinical research.
With this issue the Bulletin seeks to stimulate neurosurgeons’ feedback, both from the approximately 22 percent of AANS members who are affiliated with medical schools or academic health centers, and particularly from the balance of members who are not. How do you access and incorporate research into your practice? Is it beneficial — and possible — for a neurosurgeon today to be investigator, teacher, and practitioner, as Dr. Cushing suggested? Let us know what you think at the Bulletin, [email protected]