Great discoveries are made in many ways. Three are obvious. Luck is probably the most exciting. Discovery of gold in 1849 at Sutter’s Mill in the Sierra Nevada foothills is a good example. Perhaps even more astounding is discovery that comes from the mind of a genius. Examples are Da Vinci’s design of an airplane based on his observations of birds in flight and Einstein’s theory of relativity and its impact on our basic understanding of matter. A third avenue to great discovery is through the scientific method. Discoveries such as penicillin, MRI, television and computers were derived by thousands of incremental steps in laboratories over decades. This third way to discovery, while less dramatic than the other two, is equally productive.
Most of us are not lucky, at least not enough to discover something important or even win the lottery. And most of us are not blessed with the mind of a genius. On the other hand, most of us are blessed with intelligence and an environment that enables us to make discoveries through the “bit by bit” method. Discovery through research requires training. The same is true for skills that must be learned through training, whether those of a neurosurgeon, a baseball star or a blacksmith. The essentials of research training for neurosurgeons are known to many, but are available only to a few, unfortunately. The essentials are: 1) protected time 2) equipment and space, 3) money and 4) mentoring. The mentor knows the scientific method and how to teach it.
A Tried and True Method
The recipe for success is simple, but its execution is often complicated. The following is a typical pathway for researchers. Research begins with a question. A tentative answer is formulated in the form of a hypothesis. The answer or hypothesis must be testable, i.e., is it true or not true? The hypothesis states the essence of the experiment and is the first building block for the project. The hypothesis must have as few variables as possible. The more variables, the more difficult to test. A protocol is derived from the hypothesis, and a sequence for the experiment is formulated. The mentor is essential throughout this process because he or she provides knowledge and experience to know whether the experiment is feasible or not.
Pilot experiments then follow in order to test whether the real experiment is doable or not and whether the variables are too many or not. Statistical analysis of the data stems from the pilot study. The experiment now begins with an expectation that the hypothesis stated at the beginning will be proven or disproven by the results.
Analyzing the data is the final step of the project. Then comes writing required for presentation in the scientific literature or at a scientific meeting or both. Writing skills and precise language are essential in order for the project to be interpretable by the scientific community and publishable by journals. The satisfaction derived from a successful project can be thrilling and worth frustrations that are inevitable with any research project.
Clinical research is done in the same manner. Hypothesis testing follows a good idea. Data accumulation and statistical analysis of it are essential to prove or disprove the hypothesis. Training involves population studies, epidemiologic techniques and outcomes methodology requiring meticulous follow-up, and a stringent limitation of variables. Clinical research can be difficult because many variables are inherent in any human condition that warrants study.
There are other types of research we can do. The development of surgical tools and instruments is one. Neurosurgeons became interested in spine instrumentation because it was new to our specialty, it seemed to improve our results and it was a large part of our daily experience. Collaboration with industry paid off for all neurosurgeons, stimulating new products from industry with consultation by many practitioners. The development of outcomes research has also expanded our specialty and itts research opportunities. Clinical trials of drugs and other treatments, both prospective and retrospective, also contribute new knowledge.
Support Produces Results
The Neurosurgery Research and Education Foundation (NREF) has funded research training for young investigators for more than 20 years. More than $2 million have been expended in this effort. The track record for productivity has been remarkably good with more than 50 percent of trainees supported by the NREF pursuing careers that blend research and patient care.
The NREF continues to need the generous support of all neurosurgeons in order to continue research and development of our specialty. To make your contribution to the NREF, kindly contact Bobbi Burgstone, Director of Development, at (847) 378-0540.
Julian T. Hoff, MD, is Professor and Head of the Department of Neurosurgery at the University of Michigan (Ann Arbor) and Chair, Executive Council, Neurosurgery Research and Education Foundation.