Good evening all of you guys who are on right now. I first want to thank all of those who attended tonight. My name is Shannon Strader and I'm a rising PGY2 at the University of Louisville. I'm very excited to be continuing the AAP and AR3T Orthobiologics and Regenerative Medicine Series. The goal for the webinar series is to provide comprehensive education for physicians in training and physiatrists interested in regenerative rehabilitation while reducing stigma, misinformation, and encouraging responsible advancements for the regenerative field. AR3T is now offering a certificate of attendance for those who attend eight out of the 11 offered webinars this year. You must register at the AR3T link in the chat box that I'll be putting in a little bit later the link and ask one question in the chat box during each webinar that you attend. If you do have a question this evening please write it in the box during the webinar and we'll go over as many as time permits. It gives me great pleasure to be introducing our brilliant speaker Dr. Her. Dr. Her was born in a refugee camp in Thailand. He came to the United States when he was 10 years old. He attended the University of Wisconsin-Madison and earned a Bachelor of Science degree in Chemistry. He then attended Mayo Clinic College of Medicine in Rochester, Minnesota and became the first Hmong MD and PhD. His PhD thesis was on derangement in central metabolism that leads to development of cancer. Currently Dr. Her is a PGY-4 at the University of Wisconsin in Piedmont. He is doing research in regenerative medicine for innovation in osteoarthritis treatment. His long-term goals are to understand the pathogenesis of OA and use this knowledge to develop a viable treatment to slow its progression. Thank you so much Dr. Her. We are so thankful to have you tonight. All right thank you Shannon. What I'm going to do is I'm going to share my screen okay. Can you guys see? Yes. Okay so thank you Shannon for inviting me to be a part of this series. It's a pleasure for me to be here to talk about stem cell research and also to talk about my experiences doing research as a resident. So as Shannon mentioned I am a PGY-4 at the University of Wisconsin-Madison. For today's talk there is I have no conflict of interest and no financial disclosures. So for the talk today I have decided to organize it into three sections. The first part will be about my research projects and I'm mainly going to be focusing on the stem cell project that I am working on. And then the second part will be a practical guide that I've put together for some of you guys so that you guys can understand what some of the marks that you have to hit during your residency to get a project going and also to complete a project. And then we'll finish that with the Q&A. So just a little bit about the research project that I am working on. I am working on a total of four research projects. Three of them are clinical research and these are like so the first one here is looking at biomarkers the association of biomarkers in OA and also pain synthesizations. The second one is looking at the effects of lidocaine in hypermobile EDS patients. And then the third one is looking at the effects of radiofrequency and low back pain and also how it affects the hip and back kinematics. And the last one which I'll go into greater detail which is my stem cell project that I've been working on for the past three years. And this is basically using stem cells to generate a model that we can use to study OA. So from these three four projects I have written a total of three grants and I applied for funding. Out of the three, one got funded. So I'll go into some details about funding and also writing IRBs for this talk also. So as we all know stem cell can differentiate into any cell type in our body. What you're looking at here are cardiomyocytes derived from stem cells and it has the characteristic contraction like a heart beating in the cell culture. Imagine if you are the scientist that is seeing this for the first time. Think about the potential impact that you can have in terms of understanding the cardiac diseases pathologies but also looking at the potential of developing treatments for your patients. In the last decade, induced parapoint stem cells have emerged as a powerful in vitro model to and also a tool to screen for treatment for patients with diseases in the field of cardiology, neurology, and hematology. The to date there hasn't been a lot of studies in orthopedic diseases so that's where my that's where I you know that's where the gap in the knowledge is. So for my study I am mainly concerned about osteoarthritis and as you know this is a disease of the joint and for this particular audience I don't think I have to go into details about the joint and for this particular audience I don't think I have to go into details about the economic and health impact of OA. If you recall from your histology class the cells that is most important in terms of maintaining the cartilage and the joint is chondrocytes and there are these little guys that has you know the characteristic of you know these owl eye looking and they're really important in maintaining the integrity of the cartilage in the joint and if anything were to happen to them basically that would lead to the increased risk of developing OA in patients. So currently the gap in the knowledge is that it is unclear which biological factors contribute to the imbalance of catabolic and anabolic activities that lead to the destruction of joints and my goal is one to understand the pathogenesis of OA using stem cell as models and then two use this knowledge to develop a viable treatment for OA in the future. To do this there are multiple steps that we have to take. The first step is basically to create a model of OA and I'll show you guys how we have done that in the laboratory. The second step is to look at to identify hard marked genes that are essential in the pathogenesis of OA and we'll talk about this a little bit and then the last step is basically using these stem cells and the targets to screen for drugs that can that we can develop and refine down the road for treatments. So creating an OA model is not easy but you know the stem cell has allowed us a way to do that and so the analogy that I like to use is a plant analogy. So let's say if we take a leaf we can turn back the clock of this leaf to become a seed and then plant the seed to grow into the stem and then also differentiate that to become a leaf. In this example in OA the leaf here is peripheral blood monocytes that we have isolated from patients. We induce them to become peripotent stem cells using epizomal factors and then differentiate them to become mesenchymal stem cells and then differentiate them further to become chondrocytes. So far in the laboratory the one thing I wanted to apologize right in the in the beginning is that I won't be showing a lot of the I won't be showing data from this project because we are in the middle of writing this for our publication so stay tuned. But so far what we have done is we have already confirmed that we can take an adult cell which is monocytes and then turn back the clock and induce them to become iPSCs or induced peripotent stem cells, differentiate them to become mesenchymal stem cells and then the trilineage of chondrocytes, osteocytes and adipocytes. So we have already done this and the one thing that I wanted to talk a little bit about is here right here is the chondrocytes. So if you compare the cells that we took from patients with OA, non-OA and differentiate them to become chondrocytes compared to the native OA, non-OA it basically recapitulates the profile in terms of gene expressions and also some of the inflammatory and matric metilloproteases expression profile that corresponds to OA to OA, non-OA to OA. So after that, after generating a model, the step two is basically to identify heart mark genes that are essential in the pathogenesis of OA. And so what I have mentioned is that we took peripheral blood, isolate the monocytes which is the single nucleus cells and then induce them to become peripotent stem cells and then differentiate them to become mesenchymal stem cells and then further differentiate that to become chondrocytes. And we had obtained three samples from OA and three samples from non-OA patients. And then we also got a healthy cartilage from three patients, three different patients. And then we also got cartilage from OA patients and we got four of these. So what you can kind of see now what we're going at. So the next step is basically to take a sample of each of these, because this is the, you know, the growth of the chondrocytes. So, you know, when they're embryonic to mesenchymal stem cells to chondrocytes, and then this is mature. So comparing each stage to look at which gene is expressed at certain stage and which gene is, are downregulated. So to do that, we basically using RNA sequencing. And this is basically taking each sample and then slicing it open and take the total RNA and basically sequence it and map it back to the genome. And this allowed us to understand how many genes are turned on and which genes were turned on at that particular time and comparing them. And so when we compare all the samples from the iPSCs all the way to the native cartilage, this is like looking for a needle in a haystack. And we were trying to define genes that are important in the pathogenesis of OA. And what we started off with was about 70,000 genes. After the first couple rounds of analysis, we have narrowed that down to about 50 genes. And then we further analyze those 50 and we have narrowed it down to 11 genes. So in this stage, you know, we, at this point, we have created a model and we have almost completed step two, which is identify the heart mark genes that are essential in the pathogenesis of OA. And I am confident that with these 11 genes, if we were to knock them down or to amplify them, depending whether they're up or down at the certain stages, we can recapitulate the, we can create the phenotype of the normal gene, so the normal non-OA chondrocytes. So that's where we're at right now. And so the next step is basically, once we're done with this, we're going to do more experiments, probably going into an animal model and do a high-throughput drug screening. So that concludes the first part, and I'll be more than happy to answer any questions related to this project at the end. The second part is to, you know, to talk about a practical guide that I put together for you guys in terms of how to do research during residency. And I realized that this is, when I first thought about this, it was really, really hard to put, because each institution has different resources. Each individual has different backgrounds in terms of, and also experiences in terms of doing research. And then the level of interest that you have is pretty wide too. So it's hard to put together something that is for, you know, like one particular person. So what I've decided to do is just put something that's in the middle of the row for everybody so that you can kind of know which point that you'd have to hit throughout your residency, so that you can actually get something meaningful at the end of residency. So when I was reflecting on this and doing some research and looking at the literature, I came across this, you know, model that was proposed by Haman et al. And basically they talked about the preparatory phase, the investigative phase, and the synthesis phase. And so, and that article was for internal medicine resident, but I think that for PM&R residents and for any resident, you can use this model. And so the preparatory phase is the most important phase in terms of starting a research project for residents. And so this part, you know, take about roughly around a year at least to do, because you have to get everything right. And so a lot of these basically, you know, like, these are the steps that I will be talking about, and this is something that I modified. It's like understanding what you need to do, developing a plan, selecting a research area that you are interested in, and then picking a mentor, writing the proposal, writing the IRB, and then looking for funding. So I'll go into details about each of these and talk about my experience of how I did these. And so after that first year, so when you hit the ground, you have PGY2. If you're in a categorical program, you can start this, you know, during your intern year. But if you're in an advanced program, then you probably had to hit this, your PGY2 year. So that's the first year, and then your PGY3 year is when you actually collect the data. So depending on the type of research that you do, if you do a retrospective study, that takes probably a month to three months. If you're doing basic research like I am, that probably takes a couple of years. And then once you have this, then you can go to the data analysis part and then write your manuscript and write your abstract for our presentations. So we'll go into each of these. So the first part is the preparatory phase. And so step one is basically to understand your scholarly requirements. So this is really important because in a lot of like, I think almost all the programs require, the ACAG require every resident to be part of a project. And this is typically in the form of a QI project. And this is basically, you just talk to your program director to see if there's QI projects available that they have and they can be part of. And this is pretty easy. But in some institution, there's also an institutional requirement. And this can be in the form of a case report, an abstract to talk about a case, a post-presentation at a national conference, writing a review article all the way to publishing a manuscript. So basically the first step is make sure what you need to do at the bare minimum so that you can graduate. So step two now is developing a plan. And this is really important. If you're looking at just graduating, then you probably just need to do all the low hanging fruits, basically participate in a QI project and then write an abstract about a case that you saw in the clinic and then present that at a national conference and you're pretty much done. But if you think about fellowship, then you kind of have to do a little bit more. And what I mean by a little bit more is that if you wanted to show them that you participate in research, you have to, if you go back to the timeline here, you have to get this bulk done, like right here, the preparatory phase and the investigatory phase, done by the time that you are applying for your fellowship. And that's really important because then you can have something to show for and something to talk about during your fellowship. If you think about an academic researcher career, then now you really have to think about develop a plan, but being part of a research project that will set you the foundation so you can add on, right? So sometimes what residents try to do is that if they try to go into this track, like the academic researcher track, they do a research project that is a one-time hitter. What I mean by that is basically just doing a research project. And when you're done with that project, you can't add on to that project. So basically just a one-time deal. And that doesn't really set you up for the next step, which is what a lot of the training grants are looking for. So here's what my research plan looks like. So I did my MD, PhD at Mayo. So basically all of these, all the way to here, my prelim year here, and then I'm at this spot in terms of toward the end of my residency. Next year, I'll be going into a Payne Fellowship to do my Payne Fellowship at Mayo. So this is gonna start on July 1st. And then I'm thinking about doing a research fellowship, which is like a T32 after that, depending on the situation. And then once I'm done with that, I'm thinking about doing a K award as a faculty, and then that transition that to an R01. So it's really important that you set yourself up in this spot right here during residency for the rest of your career. And so for me, picking a research project that I can build upon. So if you listen to my stem cell research project, which is a basic science project, I can build on. So basically I'm at here, but next year, we can continue that project and we can add on and add on. And that would become the foundation to my K award. And that will become the foundation to my R01. So that's how I look at it. And then step three, so basically step one, you know what the bare minimum that you have to do to graduate. Step two, you have a plan. Now it's time for you to select a research domain. And so for this part, if you are part of the RMSTP program, Dr. Boninger and Dr. White will hammer this home that you have to pick a research domain that you can build upon. And this, for all of us, I realized that it's really hard to pick a research topic that you're gonna do for the rest of your life or throughout residency, because we have a lot of different interests. On top of that, the resources at our institution are different. So sometimes you're interested in a certain research area, but you don't have a mentor in that area. So it makes it really hard. If you look at the literature, they recommend to read scientific literature, basically to understand what are the questions that people are asking, and then what are the questions that you can potentially ask. Attend conferences and seminars. Basically, this is just to generate more interest. You can talk to your peer, your clinical faculty, basically talking to them about what are some of the things that they see in the clinics that they want to answer, and then you can generate a question that way, or talk to your research faculty. If they already have some projects going, you can be a part of that. For me, the highest yield is basically based on my research experience. So I got my PhD in molecular biology and biochemistry. And so a lot of the stuff I do is basically related to more bench, basic science research, and then my career interest and goal, which I already talked about. The next part is basically now picking a mentor. Here, it doesn't have to be that you pick a topic first and a mentor. Sometimes you can pick a mentor first, and then a research topic after. For the research mentor, there are three, according to Steiner et al, and I agree with them on this, in terms of the three mentorship domain that you have to look at. The first is relationship between mentor and mentees. This is basically guidance and support. How I look at this is an analogy that I like to use when I talk to college students that are interested in doing research is this, that think of yourself as a kite, and your mentor is flying that kite. And basically, a good mentor will allow you to basically face all the elements, the wind, the snow, whatever, that's coming your way, but will always hold onto that string so that you don't fall, meaning that whatever you do in your research career with that mentor, that mentor will be there to help you so that you don't waste time, but also allow you enough space so that you can actually learn the research methodology, learn how to do research, learn how to ask questions, learn how to develop a hypothesis, and learn how to write a research proposal. So that's what I mean by that. The second part is professional attributes of the mentor. So this is looking at their reputation, how successful they are. And this really comes into play when it's time for you to apply for a grant or for anything that you have to attach yourself to your mentor. If your mentor is not successful, it'll be really hard to apply for a training grant and said, this mentor is gonna help train me. And it'd be really hard to convince the reviewers that your mentor has the ability to help train you. So that's part that you have to think about. And then the last domain is basically the personal attributes of the mentor. So how available are they and how much do they care in terms of your development? You can pick a mentor that it's super reputable, but if that mentor has no time for you, then don't waste your time because you're not gonna get the training that you need from that mentor. So sometimes people pick two mentors. One is a reputable one, and then the other one is a secondary mentor who actually has more time. And so you can kind of do it that way if you really have to. So for me, for the step three, what I did was basically my research domain, I developed this in graduate school and also in my M3 and M4 year. When I started working with researchers in the basic science and also started learning about stem cells. So I automatically wanted to do stem cell research and OA is a really common disease that people in physiatry see all the time and also people in pain. So that's, so it aligns with my research career, my research interests and what I wanted to do. My mentor, Dr. Wan-Ju Lee. So I actually met him when I was doing an away rotation during my M4 year. And so here's some of the tips that I wanted to give you guys in terms of how to get to know your mentor before you meet your mentor. And then also how to talk to, like how to set up the first meeting and what to do during that first meeting. So what I did was when I went to my away rotation at the University of Wisconsin-Madison, I thought, I read about Dr. Lee. And so I went on PubMed and basically look him up to see how productive he was and to see if he is, how many papers his lab published per year and what they're publishing in and also looking at his laboratory website to see what are they studying. So to find out the interest and the expertise of that potential mentor. And then the second part is think about what part of his work overlaps with my own research interests. And I thought for Dr. Lee, it was a really good match because he was a stem cell guy, he was an OA guy, he was a bioengineering guy. So that kind of match up really well. And so after that, I basically email him and the email basically broken it down to three main parts, a brief introduction about who I am, what my interest, research interests are in terms of my goals and what I wanted to get out. And then also some of the relevant personal background in terms of my research experiences to show him that, hey, I've done these and I'm productive. And then I set a meeting with him. And so to the meeting, what I did was I brought a menu of my resume and so that he can actually see what I have done. And then I also asked him about his research and some of the potential projects that I can be part of after he told me about his research projects. And then I asked him about the role that I can play in the research and those research projects. And then the second meeting that I had with him was during my residency interview. And this is when I basically purposely asked the program to set me up to talk to him during the interview. And I also did this with other programs that I interview at. Basically looking through the institution, see if there's someone that I wanted to work with in terms of doing research. And I asked the program director to see if they can set me up to meet that person on the day of interviews. So I did that. And so during the second meeting, what I do is I basically, now I ask more details questions about his mentorship style and the success of his previous mentees. Because let's say if his mentees are not successful at all, if he doesn't really have a plan to make sure that his mentees, his trainees are successful, it doesn't really match well. So I talked to him about that. And the other thing I really wanted to find out is whether he has experiences working with residents. And fortunately he did. And so, because being a resident, we're super busy. So we have to make sure that someone understands that we're gonna be busy. We're not gonna be available all the time, but we're gonna work hard. So we actually came up with a really good plan and he showed me the plan, like he has a blueprint of how to get the trainees from to be successful in terms of doing research. And I really liked that. And so I thought it was a really good match. Now, after you found your research topic, you found a mentor, now it's time to look at the research proposal. And so the research proposal here is gonna be basically what's gonna take the majority of your preparatory phase. The, so it's basically developing your research question, your hypothesis. And so to do that, not a lot of people take advantage of the medical librarian that is assigned to the department. And my advice to you guys is please talk to them first because they will show you how to navigate the search engines like PubMed and whatnot to find out then to narrow down your research topics so that to something that is tangible that you can actually manage. Because sometimes if you just throw stem cell and osteoarthritis, you get thousands of articles and it's like, which one do you start? So basically make sure you have a question and you have the medical librarian help you to narrow that down to like a hundred and you can pick like 10 to read and you can go from there. And then the other part is to build your research team. And this, for my other projects, I thought it was really important to get the biostatistician involved to talk to potential collaborators and also other experts in the field about the project. And so sharing with them about what I'm thinking about my research question, my hypothesis and my aims and just have like them give me some feedbacks on those. And I thought that was really good because some of the ideas, you can have the best idea that there is. But if the biostatistician said, it's gonna require you 300 subjects to be enrolled in two separate arms, you cannot do that as a resident, that's impossible. So you really have to ask the question that you can actually do and the biostatistician will help you with that. And also your collaborators and the other experts in the field will tell you, oh, we've worked with this machine to study this component that you're interested. And you actually have to find out if your institution has that machine. Because you can write it in your research design and methods, but if you don't have the equipment, you can't carry that out. So that will save you a lot of time. And so the first part in terms of the research component proposal is to work on is the specific aim. Other people make the mistake of going to the background, the research design, the timeline, all that stuff, don't go there first because you're gonna waste your time. Go to the specific aims. And so this here, I put this, and this is a photo of my book and that I purchased the grant application writer's workbook. And it will tell you how to write a specific aim page. And what this is basically in a nutshell is that it's a brief overview about your research, your question, your hypothesis and some of the objectives that you wanna do and some of the primary secondary outcomes that you want it to look at. And so start with that. And so write this research with this specific aim page and give it back to the statistician, the biostatistician, give it to your collaborators, give it to your mentors, give it to anyone, have them read it and have them give you feedback. Because this is gonna be bouncing back and forth like more than 10 times before you can actually have something that you think you can do. And so once you have your specific aim page, right in the background, the significance is going to be really easy. The research design methods can be really easy because it's all going to be from your research, your specific aim page. The timeline, and then something to consider is the ethical risk slash risk consideration, because that's going to be important for your IRB. So write this first. And then for step five, so once you have a research proposal written, now you go and you contact your institutional coordinator about the IRB protocol. And so usually each department has a coordinator that will help you with it. So there's like, they will email you an outline and what some of the things that you have to put it in the IRB protocol. And what I found from my studies is that if you write a really good research proposal, a lot of the stuff in here, you can copy and paste directly into the IRB protocol. The only section that you have to expand on is the risk section. So all research has a risk, even if you don't do anything. Boredom is a risk. Asking too many questions on a questionnaire is a risk. So you have to really justify why your research design or your protocol is the best way to ask that to be done. If there's a different way, then you have to use that different way. And so you have to justify that. And so for one of my research study, which is the lidocaine and looking at the effects of lidocaine in hypermobile ADS, I, one of the risks is that we measure them and we try to find the quantification of their pressure sensitivity. So basically, and also pinprick. And so with the pinprick, they're really picky on, will that pierce through the skin? Will that cause an infection? So you have to write about, I have to write about the ways in which I will minimize infection risk, the way in which I will minimize pain. And so I have to talk about that. And so if you felt your research, if you write your research proposal correctly and you've done it the best you can, you can lift a lot of this stuff and the IRB protocol will be really easy for you. Step six is funding. So funding, so I wanted to say from the onset that it's unrealistic to expect a resident to get funding for their research project. However, if you already spent time doing the research, writing your research proposal, going through the IRB, you might as well just submit that for funding because this is all components of the writing a grant. So you can just basically, you already done all the work. So just basically just put that together and submit that for funding. The worst thing can happen is that they say no, which happens to me quite often. But if in the times that they say yes, you have some money, you can do stuff with it. So that's, so I cannot stress how important it is to get the first step right, which is the preparatory phase. You have to get that right. If you don't, everything else after that will fall through and you will waste a lot of time. So this is probably done in your PGY2 year. And then your PGY3 year, so this is the investigatory phase and so collecting the data. So, and I put here again, should not be used to accomplish the preparatory task of the preparatory phase. This should be in the investigative phase. So if you have research time, research elective, use it. If you have elective, use it for your research project because research is time consuming. And if you don't dedicate the amount of time to do it, you will not get it done because everything will add up and toward the end, you're gonna be overwhelmed with all the stuff that you have to do. So, and some, here's some of the barriers that I found online about, to completing a research project for residents. Basically insufficient time, low priority relative to patient care and because you are a resident, you're there to take care of patients. That's priority number one, research priority number two. So you have to really make sure that you have dedicated time for the research to get that done. And also poor availability of the mentors, lack of direction from residency program because sometimes some programs, they try to do research but they don't know how to do it correctly and they gave you the wrong advice and that's what can lead to problems. So, for me, what I did was here at UW, I have three months of elected time. And so I basically set it up in my PGY2 year, my PGY3 year. So from October to the end of December of my PGY3 year, I had that time dedicated just to do research. And so that, I found that to be really fruitful. And then you'd collect the data and then you move to the next phase which is the synthesis part. So this part, depending on how big your data and how much you have to analyze, you might have to ask a biostatistician to help analyze your data. The one thing you should not and should not do is do not hand spreadsheet of raw data to the statistician because this is a nightmare. I was part of a QI project and someone asked me for help and they handed me raw data and I looked at it and they wanted me to analyze it and give the result back the next day. And I looked at it and it was like, I didn't even know, like all the units were off, all the time that they recorded was in, some of them were in like a military time, some of them were in a 12 hour kind of time. So I have to convert all of that. And it took me like six hours to do that. And then the analysis part only took me five minutes. So don't do that to a statistician because if you hand them that, they will just throw back at you and said, we have to tell me what are your specific aims? What are the interventions? What are the outcomes that you're looking at? And what should I do with this? So make sure you do that. And then you prep your, and then now that you have your data, you analyze it, you can basically write an abstract, present it at that at a national conference or write a manuscript and try to submit that for propagation. So again, this is like a guide that I put together that I think that might be helpful for you guys. So PGY2, make sure you get your preparatory phase done and then done it correctly and then do your PGY3 year, make sure that you collect your data, make sure that you have time to, dedicated to collect that data. And then you have to ask a statistician to help you with some data analysis and basically writing your manuscript. And this is, so by the end of your PGY4 year, hopefully you have something that you can show and say, hey, I did some research and I was successful. So these are my references. There's a lot of people that I have to thank. So Dr. Li is my basic science researcher. I work with Terry Li, who's a graduate student on the project and then Hong Li and Alan and Brian, all of them are really helpful in the lab in terms of teaching me techniques and also what they're working on. Dr. Sehgal, she is a mentor for me for two of the clinical projects. Dr. Rudin, he's one of the mentor for one of the clinical projects. Dr. Leonard, he's a really great guy, great cheerleader, always really helpful. And then Dr. Shalek, who has been instrumental in terms of being a friend, but also being a supporter and giving me the advice to navigate both the research realm and also the clinical realm. Thank you. I will open the floor to any questions that you may have. Thank you so much. That was wonderful. I learned a lot myself. So the first question we have is, did you discuss with residency programs, directors, leaderships before committing to a program about balancing basic science research beginning in early residency training? Sorry, can you repeat that question? Oh, for sure. Did you discuss with residency program directors slash leadership before committing to a program about balancing basic science research beginning in early residency training? Yeah, so I did. When I was an M4, I did my weight rotation here. I spoke with Dr. Leonard at the time he was the division chair. And I told him about my vision and what I wanted to do and to see if that was supported by the residency program. And so when, and there was no hesitation in terms of what they can see me bring in terms of a different skill set, but also what I can bring to the residency program and to the university as a whole. So yeah, so I did discuss. And then I also talked to the program director before. And then when I got here, I also talked to them about exactly what I need, what I needed. And it has been really great to work with Dr. Leonard when he was the chair. And then now Dr. Sehgal, who is the division chair, because they have been really helpful in terms of allowing me the flexibility that I need to make sure that I can get the research done. Second question, how much time should residents who plan to apply for fellowships such as paint or sports anticipate dedicating towards research? So I'll tell you what I did. So, you know, like for the basic science research, there is no, so for residency training, we are so busy, right? So what I've done is I basically spend nights and weekends and then working with the graduate students and my mentor in terms of making sure that things get going when I'm not there, and then see what they can help me with and what I can help them with when I'm there. So that, and then, you know, like, and then the other projects, I basically just did those on my spare time. They're a lot easier than the basic science project, not so much time consuming as more just putting something together and then talking to the right people. And then for the, you know, for the fellowship, I knew from the onset that I wanted to do a paint fellowship before I got into residency. So basically, you know, you have to find out exactly what you need to do to become a competitive applicant for the paint fellowship, which I did. And I spoke with our paint fellowship director here about that. And then, you know, like, and when I applied, like, to be honest with you, I didn't apply to that many programs. I applied to a total of five programs, got interviewed at all five, and then got, you know, and then went to the program that I thought was best fit for me. So the short answer is I didn't really spend that much time thinking about my fellowship. I thought I concentrated more on the research because that put me at a competitive edge in terms of for the fellowship. Does that make sense? Yes, thank you. If you only have one month for elective, would you recommend prioritizing exposure and a potential fellowship specialty via clinical rotation or research in a specialty field you're interested in? Well, that's hard, right? That's really hard. I think that, so, you know, like traditionally, what people would do in terms of if they really wanted to do research and to go into a fellowship is that they do a review article on a topic that they really wanted to do research and then carry that momentum into the fellowship. Does that make sense? If you have a choice between doing research and doing like, is this more of like an away rotation or if that rotation is like that elective is within your institution, I think like for here, I am fortunate that we have three months of exposure to the fellowship. So that I thought was sufficient time. So I just concentrate more on my research. But if you want it to do it in a way rotation, I think that I'm biased in the sense that I think that you should concentrate on building your resume so that it makes you competitive. And then when you interview, you can show them what you can bring to the program. All right, so I think we have time for only one more question. Would you recommend only doing research with a mentor at your program or would you recommend reaching out to attendings from different programs if they're performing work you're interested in? Yeah, so that is a really good question. And so my advice is to do research that is close to you. So if the mentor is in your institution, that's the first thing to do. It's hard to do research with a mentor that you cannot see face-to-face, with even with FaceTime, doing like Zoom meeting and whatnot. It's not the same as you talking to them face-to-face and setting up that meeting. So I think that if you can find a mentor in your own institution, that doing the research that you need to do, that you wanna do, I would go there first. But if you really, really have to, and there's no other way for you to do research other than to go outside of your institution, then that's what you have to do. But I think that it's more risky because the productivity might not be as what you expect it to be. Thank you so much, Dr. Hur. I really appreciate it again. There's several other questions, but if you guys wanna email me or Dr. Hur, if you want me to share your email for them to get in touch if they have any questions, I'll do that. I just wanna mention that our next Orthobiologics and Regen Med Series webinar is July 6th from Dr. Zubin Master. He is one of the top stem cell ethics researchers and PhDs from Mayo Clinic. And he works with all the big names in sports and pain. And he is going to talk about all the ethics and what we kinda need to go forward from here clinically and bench research wise. So I look forward to seeing you all there on July 6th too. So what I'm gonna do is put my email on the chat. So if you guys have any questions, just feel free to reach out to me. And I'll try to answer as many questions as I can. And yeah, and we'll go from there. Thank you again. Have a good night, everybody. All right. You guys have a good night. Thank you. Thanks a lot.

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