If I talk a little bit about research, and let me just ask you, how many of you are going into an academic practice? So most of you. So you guys have a real reason to do this. I think one of my great mentors is a guy that's running around this meeting called Steve Weber. Steve doesn't know that I think so highly of him, I don't know him all that well. But Steve was in private practice in Sacramento, California, and he used to publish randomized clinical trials, and he was the only author. Can you imagine? Private practice, randomized clinical trial, you're it. So if you're in private practice, you can do this stuff. But the truth is, is that I think the reason Mary asked me to give this talk is that I'm an idiot, honestly. And I'm going to show you just how bad I was at this stuff, and how, so there's no excuse for anybody, if you're interested in doing this stuff, that you can't become halfway proficient at it, because I did. And I'm not kidding you when I say that. And here's the point, I'm going to just distill it down, it's going to be very informal. If you came here for p-values and meta-analyses, you've got to go someplace else, because it's too late in the day and too late in the meeting. But I'm just going to tell you this, and the key to this whole thing is understanding this point, that all good research has to start with a good question. The truth is, you're shitty at asking questions. So am I. We are all bad at it. Because the better your question, then the research kind of does itself. The problem with it is, is that many of us just don't ask the question. So here's what we call Tokish's three rules for committing to a project, okay, with that question. You ask a question, and I tell you it's got to be three things, and Angelina's back there having a small seizure, because she's heard this about a hundred times from me. It's got to be interesting. Do you really want to be the world's expert on fibromyalgia? I mean, don't ask the question if you're not willing to put a whole bunch of time in. I asked a question about rat rotator cuff models, and now I fix rat rotator cuffs. I hate it. But every Friday, I go and I do rat rotator cuff repair. And somewhere in there, it's kind of interesting. But it's hard work. It's monotonous. And you have to ask yourself, is the question interesting? What does interesting mean? Well, interesting can mean a lot of things. But it has to be interesting to you, because you're going to spend a whole shit ton of time spending time on this. So please understand that. Don't publish just for the sake of publishing. I get it. I can help you in having some numbers under there, professorship, and you want your 50 or whatever number of papers you have in your head if you're like that. But I would just tell you, it's a long process. I always remember when I came out of fellowship, and they used to say this, Russ Warren, who's published about three billion papers, did not publish a paper in his first five years out of training. That's like urban legend. And then he literally has a thousand papers, I think, out there. So don't worry. You don't have to publish every day or every month and find things that are interesting. Second, it has to be doable. And I'm going to give you some examples of that. Do not, I mean, you're here, so I know a couple things about you. Number one, you have wasted a ton of your time on research that wasn't fruitful, because all of us have, right? You got grabbed by that one attending. Did you have that one attending? Because I did. I love him. I won't mention his name. But he was, I hate to say this, but he was super interested in the most esoteric things. So he'd have you come, and he'd get some poor intern, and so you'd get warned if they liked you. And they'd say, hey, don't go over to so-and-so's house, because he's going to get you involved in these five-year research projects, and no one has ever published a paper out of it. I kid you not. It has to be doable. And the question is, is how do you know whether it's doable? Well, you got to get a little better, right? So these are tools in your toolbox. And then it has to be a publishable. But I might say, not just publishable, but of value to you, meaning it doesn't have to be publishable. It could be presentable. It could be patentable. There's lots of rooms for what's valuable, but at the end of the day, it has to be valuable to you. So it has to be interesting. So look at this study. Shoulder Arthroplasty in the U.S. Medicare Population, a One-Year Evaluation of Surgical Complications, Hospital Admissions, and Revision Surgery. I almost fell asleep reading through the title. And I'm on that paper, okay? That is not an interesting paper to me. And we spent a lot of time on it. This is not one of those Pearl Diver things where you look through. That was the entire U.S. Medicare database. And we went through to find actual cases. So it wasn't just a skim. And Sarah Floyd, who's on that paper, and Cole Chaplin, who are the two, they're economists. So the truth is, is that it wasn't interesting to me, but it was Cole's first paper. And so what was interesting to me about that paper was the fact that he was on fire about this thing. He made these guitar graphs. I mean, he's a genius, but he'd never really done much in the way of research. So as we first started it, I thought, I'd rather stick a stick in my eye than work on this paper. It was awful. But if you change your focus a little bit and figure out why is this interesting, well, it was interesting because of him and because of the team that we worked on. And I got to know the economists and learn how to think entirely differently. Those people I started meeting once a week with for a year, and I promise you it was six months before we even spoke the same language. We'd argue about the definition of is for a long time with economists. And I got so much better because I learned how to speak their language a little bit. Now I quote all kinds of economic shit. It's hilarious. Secondly, it's got to be doable. This is Tokish's first research paper, okay? 1993, it's not published, and that's because it's supposed to be doable, and I was shitty at it. This is the story. I'm in medical school at the University of Washington. David Ayer is one of the most respected biochemists in the world, and he had developed an assay called the NTX assay, where he could measure bone turnover in urine, okay? So bone turnover in urine is fascinating. And so what he was interested in looking at was people take corticosteroids, and how does that affect bone urine? I needed a project, and I was like, I don't know anything about, barely know anything about urine, let alone about bone turnover. But I went and met with him, and he's like, well, what do you got for me? What are you going to bring to this study? So this is how bad I was. I was a meathead, and I'd played college football, so I knew my way around a gym, and that was about it. And so I said, well, I don't know, what about anabolic steroids? Have you looked at that before? Because, you know, I was interested in that. And he said, that sounds great. So I went to my gym, and I convinced, like, 20 meatheads to give me their urine in a cup. I swear to you, okay? Now keep in mind, forget about the fact that if you're going to measure bone breakdown in urine, that you have to have cyclical stuff, and you have to have, I had a one-page thing. First of all, I said, I'm not a police officer. That's what I had to put on the paper and sign it, because they were all worried I was going to bust them, because they're giving urine, and they're taking illegal drugs, okay? So I get 20 dudes to give me this, and I don't have any place to put it, and the guy goes on sabbatical, so I take it to my mom's house, and I stick it in her freezer. She's like, what's in the freezer? I go, it ain't popsicles, mom, leave it alone. I'll take care of it later, okay? You want to talk about shitty research? Because listen, you got a shitty research thing that you did, I will top you, I promise. I've made more mistakes. All right, so this is a long story, but eventually, because it was a medical student-sponsored project, they included it in an abstract. It's an aberration against all things holy, and I had to present this thing. But is it valuable? Yeah, because they paid my way down to Carmel, California, and I got to do a five-minute presentation, and they had a real scientist, a biochemist, that was my moderator, and afterwards, he started up with me, and he just said, just leave, just leave. And he was right. It was awful. Okay? So, you think you're bad at it, or maybe you don't have a really good starting point? Listen, I got you topped on that, all right? So, and then, I never finished the project, so after I graduated medical school, my mom, in front of my medical school graduation gifts, was to give me a frozen thing of urine that was still in the freezer downstairs. What about valuable? Okay, when I went to my residency, and I went and found our guys, and I said, listen, I got to get better at this, because I was pretty scarred from the previous experience. And he goes, you got to figure out something that we do well. What's your idea? I said, well, I want to do a randomized clinical trial of ACLs with bone patella tendon bone versus hamstring. Okay? That was my big idea, and it hadn't been done yet. And he's like, great, how many ACLs do we do? And I said, I have no idea. So, I went and looked. So, we like did 20 a year. So, then we did the numbers. It would take me like 23 years to get that study done, right? It has to be doable. So, I'm starting to think. I'm like, how the hell do I figure this thing out? So, what do we do? Well, I'm in southern Arizona. I get three snake bites on for that night. Snake bites. So, I'm like, I don't know. Let's look up snake bites. This was my first paper. It was second publication-wise. But my first paper, you want to talk about interesting. Holy smokes. Everybody wanted this paper, and the reason I bring this up is that is Chateau Lake Louise in the Canadian Rockies, and I went for a week on my program's dime, because that was the rule back then, with no vacation, and presented that snake bite talk twice. And I drank a lot of booze, and I went on the lake, and it was phenomenal, and I thought we should be the most published program in the country. They pay for this shit. Okay? But of course, we spent a lot of money on that one, and so there became the Tokish Addendum at the University of Arizona, where they started limiting the amount of money that you could spend on a research project. But that stupid little project turned into the largest snake bite series ever published. And I learned a ton about how to write a paper, about how to do revisions, about basics of statistical analysis, and all I'm doing is chasing Chateau Lake Louise down the road. So don't be afraid to look at those sort of intangibles, if you will. Okay, next one. Be inclusive. I got out of my fellowship in 2001, and I went home to my practice at the Air Force Academy. I was there, and we saw a ton of instability. Ton. Ton. And I had done about 20 arthroscopic panlabral lesions. We called them firestone lesions back then, because firestone tires had that problem where their tires blew up. Remember that? And then I was going to publish that, and Hawk said, don't do that, you're going to sue your ass. So I was like, okay, I won't do that. So we called them panlabral lesions, which is what stuck. Okay, so I went down to a meeting, and they asked me to give a talk, and I thought, this is my thing. I mean, this is the only thing I've done that I think I'm pretty good at. And so I stand up, and over there is Jimmy Andrews. And Jimmy Andrews presents this case, and it's a panlabral lesion. And they're talking about it. It's a big deal. And I'm like, so I present mine, and I've got 20 of them. And Jimmy goes, hey, nice job. How many of them you got? I said, about 20 of them, sir. And he looks over across the room at his research assistant, and he goes, how many we got? And they go, about 20 of them, sir. He goes, get that published by Monday. So I urinated on myself as I walked off the podium. But here's the lesson. I went to a SOMOS meeting, and I met Matt Preventer. And Matt heard this talk, and he says, hey, man, we've got a bunch of those. And honestly, I didn't know Matt back then. And I walked away from that. It was one of our first meetings. And I walked away, and I went, that's kind of my thing. And I struggled a little bit, honestly, with being selfish. I thought, this is my thing. It's ready to go. Frickin' Andrews is going to publish it tomorrow anyway. And then it's off. Scoop. Don't get scooped. So I really stressed out about it. And in the end, I was like, you know, I just should be a better teammate. So I said, yeah, Matt, let's do it. So he brought, like, 25, I brought 25, and that paper became my first JBJS paper. More importantly, it started this incredible friendship with a guy that's a 20 times better researcher than me. And I've learned a ton about teamwork and collaboration and everything else. So my point to you is, be inclusive, collaborate. Don't think it's yours. Make it ours. And I've been guilty of that. And so if you can learn that lesson from me instead of not with me, I think you'll find it. Build or join a team. That started what's now the Motion Program. We started it as the SOMOS Research Society. I put out an open call for anyone who was interested. I called it the Coalition of the Willing. I even brought snacks. One person showed up, Matt Preventer, back before his fellowship. And then he became Matt Preventer. And then that leads to things like the Near Circle, the Delphi process. And I learned how to do what Delphi processes are and consensus building and things like that. The next lesson I tell you is get out of your lane. You guys read this book, Range? It was mentioned yesterday by Steve Burkhart in his innovation lecture. This is David Epstein. He was a speaker here for us at Anna. And David's a genius, and I don't have time to go into what he does. But essentially, this is what it is. We're all subspecialists, right? I just do left shoulder rotator cuffs. That's it. Just kidding. But there's a problem with that. The people who are going to be most successful are the people who are what he calls polymaths. Yeah, you're good at one thing, but you can reach across the aisle. And time and time again, the most important things I've done in research is because I listened to somebody who was out of my lane. I went, huh, that's kind of interesting. Let me learn something from you about that. I'm a really good learner. I am. I'm super fascinated in lots of different stuff. You'd think of some of my hobbies, and you'd think I'm really creepy weird. And it's probably true. But out of that paper became, you know, back then in the U.S. military, we were having two suicides a day. Two suicides a day. And so we were doing hip arthroscopy. I did hip arthroscopy back then. And so, you know, you'd have these questionable outcomes, and so they'd say, well, don't worry about them. I had a failure, and one of the guys comes back and he says, don't worry, because all the hip arthroscopy patients are crazy. And they're all drug addicted. And that was like, bing, and I went, is that true? So we looked it up. This is, I think, Justin Ernest, the lead author on that, just finishing his fellowship now. Justin's brilliant. And he went and found the data for us and everything else. And what we found is, he was right. I'm just kidding. They weren't crazy. But the mental health, the people who were on medication was incredibly high. And, in fact, it wasn't just hip arthroscopy. It's throughout the U.S. military. And that became something that was really important to us. Now, you want to talk about something that was interesting. Holy crap. And publishable. Shit, I published a JVJS paper on hip arthroscopy. Come on. Doesn't happen. That was awesome. And that's what you learn because you ask a question about something that's outside of your lane. And that got me interested. Well, how do we stop this stuff? And how does it affect, if mental health affects hip arthroscopy, what about shoulder instability? What about other things? And we got into this interest in this concept of resilience. So I had already built this military outcomes platform. And so we didn't want to add any more questions. So they said find the shortest questions possible. So we came up with a brief resiliency score. And we got interested in resilience. And here's the interesting part about this study and the several that followed. We analyzed all of the factors that went into your outcome after shoulder surgery. And we've done it now in three or four different cohorts. We even have a professional baseball team that this has proven true in. We just can't publish it because the team thinks it's so valuable to them that I'm working with. They've asked us not to publish it yet for another three years. It's unbelievable. When we looked at what matters in terms of your outcomes, it had nothing to do with who your surgeon was, whether it was a revision, whether it was work comp, whether you had a complication. It simply correlated 30% of your value on what your preoperative resilience score was. Do you know what your resilience is? Because you might be surprised. It's a bell curve. I looked after Marines. Marines, you'd think, I thought, you're going to have 98% of them over here and you might have a couple that had a really rough time in the war maybe over here. Not true. Bell curve. Professional baseball players. Bell curve. Orthopedic surgeons. Bell curve. You're not as resilient as you think. And it affects you far more than you know. Get out of your lane. And you can learn things about our patients and about how to get them better. I mean, I finished that project and I'm like, I shouldn't be doing surgery. We should just design a resilience program, help to see if it's modifiable, and then I'd be the best surgeon on the planet. It's unbelievable. And that's held true over the years. All right. Well, you didn't necessarily come to here ranting, although you stuck with it. What about some of the mechanics of how we do these things? Well, you've got to learn how a paper gets accepted, right? So you spend all this time on a paper and then you get these reviewer comments back. There's always three reviewers. They're blinded to you, by the way. and then you get them back, and one of them says it's unbelievable, and one of them writes back something that's a stupid thing, clearly they didn't read the paper very well, and then one of them says, yeah, I think there's some pretty good stuff here, and you're like, write on, and the paper's rejected. And you're like, son of a bitch, there's no way, I mean, look at this thing. And that's probably a problem with the reviewers. But here's the thing, you've got to learn what makes a paper accepted. You don't know. I didn't know. And this is to JR's point, and everybody that you've heard, how do you learn it? I'm a reviewer. I became a reviewer with ASES, that was my first opportunity. I thought you had to be asked. You don't have to be asked. Listen, we need reviewers. Ask Jim Lubowitz. He'll take you today. Now your review better be in tomorrow if you're working for Jim, because he doesn't jack around. I couldn't do it for arthroscopy, man. He's so efficient. His turnaround times are literally less than three days. I'm not kidding you. And yours better be. So we'd love you to join. If you're kind of one of those meticulous people, do it. I did ASES, and that's because Bill Mallon asked me to. At one point he came and he said, you're the hardest reviewer we have, you never accept a paper. He said, in fact, if I read a paper and I think I don't like it, it could be good. I just don't like it, I send it to you because I know it's going to get rejected. And I'm like, that's unfair. And we've looked at the data, and it's not as bad as Bill said, but I've spent a ton of time on those, and I read everybody else's reviews. And at first it was like, God, I missed that. God, I missed that. That was terrible. Oh, yeah, wow. I didn't even think of that confounder. I've now done it for 12 years. I'm now the associate editor. But back in the day when I was reading all those and turning all these in, I got really good. And then when the paper was accepted, I read what it was about those other reviewers who were way smarter than me. Now, I know exactly what a paper needs to be accepted. You can bring me horseshit on toast, and I can write it in a way that'll give you a fighting chance. But that's only because I've read it over and over again. It's a learned process. How do you learn it? Become a reviewer. Learn to refine your question. I always say this to our guys. Look, if you want to publish, you've got to be first, biggest, or best. And if you're not one of those three, then you've got to pay for it, right? Because we're in this pay-to-play thing. And that's a love-hate relationship. That's a whole other conversation with me about pay-to-play. And originally I was like, oh, my God, no way. And now I see some value in it, and it's really tough. But we all want to be JBJS, arthroscopy, AJSM, right? When you get that one back and you go into some of the lower-tier journals, now you can get published anything, as long as you're willing to pay for it, right? But changes are coming. And the change is going to be things like impact factor and open access that you didn't pay for, et cetera. It's going to become harder again. And it's not, you know, I mean, we all want to get there, but you've got to refine your question. Learn how to do that. How do you know how to refine a question? How do you know how to ask the right question and then go find out? Well, this is what I tell our guys. Every question's first publication should be a systematic review on the topic. You don't know what you don't know. So how do you know that? Well, you go read the literature. No, you don't. You have an organized approach to reading the literature, because that's paper number one with your question, okay? You say, I don't know how to write a systematic review. Don't worry. Josh Harrison and Dave Flanagan do. They've written like 50. In fact, it's affectionately known in some circles as a rush orthopedic book report, right? Sorry, Brian. They've written like 19 of them. But it's genius. When you finish a systematic review, you will know more about a particular topic in question than anyone on the planet. You could be an R2, a med student, and you know more than Lou McIntyre? That's impossible, but it's true about one thing, about one thing. That's paper number one, because then you've just refined your question. Your question might totally change. I don't know. That's not going to work. You think that now I'm old, and I've published a whole bunch of papers, and I'm past all that? This is 2021, one month ago. This is a systematic review of a question we're trying to ask on the biomechanics of what happens to your scapula when your shoulder raises, an area of interest of mine. And it's mostly because we're patent. We got two patent things we're working on, and it's kind of crazy. But I didn't even know what question to ask. So that's me, and my fellow, and one of my residents, and then a whole bunch of other people who kind of jumped on, be inclusive. But I still do this. I still read these papers. I still delve into it to figure out what I know, what I don't know, and what the nuances are. That's what enables you to ask the question that publishes the paper, right? Other mechanics. Invest in staff and partners who will help keep the trucks moving. If you can afford it, hire a research assistant if you can get it. Find a young resident. If you're really slick, you can con your girlfriend into coming and helping you. That snakebite paper I showed you, there was this cute little girl that I found in the hospital, a nurse that worked there, who was the head of research for anesthesia. And I'm not saying that had anything to do with it, but 21 years later, that cute girl is my wife. And she's still better at research than I am. But we met kind of going over this thing, and I had sort of a funny response with that. But she was super, really good, and remains really organized, which is not my skill set. So find somebody that fills the gaps that you don't have. Maybe for your spouse too, but I ain't giving that kind of advice. But in terms of your research life, find somebody who, figure out what your weaknesses are. Mine is organization. I'm not an organization, I'm not a very good organized guy. And she is. And I have, I'm blessed now with some team members who are super organized. That will make you more efficient. So identify your flaws. What else about project management? This is what I'm going to tell you about procrastination. Projects are like grilling. These are some sweet barbecue ribs, and if you ever come to the house, I'm happy to grill them for you. Start fast, and then turn down the heat, and let the juices take their time. You are crammers. You're all procrastinators. Some of you are worse. You're pre-procrastinators. You heard that term? It's now officially a scientific thing, I'm going to tell you about it. You think procrastination is wrong. Procrastination has some advantages. I'm a procrastinator. That paper, that's a book chapter that you saw below. I include that one because I wrote the edition before that, and I wrote that one. The edition before that, I wrote in one sitting and one night. From 12 o'clock to 7, why? Because it was due the next day. I hated it. I hated the process. I hated the project. I wasn't all that proud of my work. I'm a decent writer, so by the time it was done, it's fine. The next year, or two, three, five years later, whatever, when I wrote the second edition of that, I said, I've got this wrong. So what I did was this. I'd listen to, I don't know if you've heard of Gladwell stuff, Malcolm Gladwell, revisionist history. He used to take one thing away, listen to some of his podcasts on these. He's got one on procrastination, spoke to my heart. And because they didn't judge me for being such a procrastinator. So I always said the same thing, that the best thing about leaving things to the last minute is it only takes a minute. And if you think about that for a minute now, and you're good at it, I'm good at it, but the problem is you hate it, you stress about it, it becomes this weighing, anxiety-filled thing on you. Fix that about your life. And believe me, I'm not perfect at this, but I am so much better. This chapter that I wrote in Madsen's, I started early, and then I stopped and just let it simmer. I want you to procrastinate. It's the best thing. There's science behind this now. But you have to start early, so it's motorizing in your head, okay? There's this, one of the things, one of the stories he tells is about the company Warby Parker, you know, the billion-dollar glasses company. This guy taught a big graduate economics course at his institution, and he offered these guys and said, bring me your proposals. They brought him this proposal with Warby Parker, and they said, give me your three-month thing. And by the time three months came, the guys didn't bring anything. So at six months, he went back and he goes, I'm not investing in your guys' company. This is like Wharton School of Business stuff. Okay. So then it goes out and the guys sold the company eventually for a billion dollars. He went back to the guy, he goes, what the hell? How come you guys didn't let me invest in this? We tried, you wouldn't do it. Why didn't you invest in us? And he goes, because I thought you guys were lazy. It wasn't that. They had an idea. Get that on paper, get an outline out there, and then let it simmer for a little while and go forward from there. That's how you're going to be successful with this thing. So that's the thing I've learned, because there is something called pre-crastination. Some of you have this, where all you can do is your next thing. It allows you not to focus. You're just on to the next email, the next text message, the next phone call, and you never take time to sit down and actually cram. Because cramming is incredibly juicy, flowy kind of creating. You don't want to be cramming 12 o'clock the night before it's due. You want to be able to do those in little spurts. So it's okay to be a procrastinator. Just start slow and let it cook on the grill. Active procrastination begins with an outline, then break it up into smaller pieces. You guys know how you eat an elephant? One bite at a time. So now I have much better, I have a project management approach. I'll take it and I'll say, okay, I got to get this book chapter done, or I got to get this paper done. And I don't sit down, I look at it and I go, when am I going to have nine hours to write a chapter? I don't. Ever. Neither do you. But I can sit down and write the methods section. I can sit down and write the abstract session. And that's got to be a victory. Doesn't feel like a victory, because you know what I mean, it doesn't work unless you're at the end of it. But it's a victory. And you got to redefine how you do that. Be relentless in revisions. Once that paper's in and you get it back, and they have marked it up unfairly with all 35 stupid questions that the jackasses wrote back to you, and I'm offended when you do this to me, I hate it. So this is the lesson I learned here. Clinical validation of the glenoid tract concept. We submitted this to JBGS, thought it was pretty decent work, and they gave us a revision. And we revised it seven times. The first time had 35 different things we had to address. In fact, revision six, they made requests for us to go back and make it look just like revision five, unbeknownst to them. I kid you not. Andy Green is the associate editor on this. And on revision number seven, I wrote a letter that said, dear Andy, I want to thank you again for your request for revisions. And honestly, you've contributed now so much to this paper that I'd like to offer you authorship. And he politely told me to do something, and then that was the last revision. So maybe I should have written that on the first one. Next, count the cost. If this isn't you, don't do it. It's okay. You don't have to. I mean, there are people I know that are really good at research, but it's just not their thing. It's okay. We interviewed all the fellows for Stedman Hawkins and Vale when it was still Stedman Hawkins for a long time, and one of the guys that impressed us the most was a guy named Scott Hacker. He's now, he got the fellowship spot. He published 80 papers as a resident. I don't know if that's a thing anymore, if that's a big deal, but when I was coming through and the 10 years after, Waterman's like, 80 papers, that's a Saturday. Dude, what are you talking about? But that's a big deal. And so he comes up and people are salivating, all right, because you know, I don't know if you know this, but when you went and interviewed for your fellowship, it wasn't about all that mentorship stuff. It's about, that cat's a horse, and he or she is going to publish a ton for me. This is going to be great, right? What can you do for me? There's a lot of that that goes on, especially in some of these places. Well, people were salivating. They asked him, what do you want to do in your fellowship? And he goes, you know, publishing is hard. We're waiting for the follow-on. He didn't say in the follow-on. He goes, I don't want to do that this year. I just want to do clinical things, and it was such an honest answer, he got the spot based upon that answer. It was crazy. So if it ain't you, don't make it be you. Saying yes means saying no to something else, right? You've heard that. It's an incredible time sink away from other things of value, especially if you have a My wife were here. She'd attest to that. She'd tell you, these were not easy days. I'm off doing whatever. And there's a lot of costs that you make. It can become a really love-hate relationship. You don't want to get to the point where one of your friends calls you and said, hey, would you contribute a chapter, and you get off the phone and you just start cussing to yourself. That's a terrible place to be, and I know because I've been there. Hell, I'm there sometimes now, where you go, please don't. It's such an honor to be invited to do something, and if you're so stuck in that box where all and you haven't learned how to manage your time and break it up and take the elephant one bite at a time, it becomes really antagonistic, huh? So learn to delegate. Learn to delegate. Learn to delegate. Find a partner. Find a med student. They're more eager than you. There are things they can do. Get out of your own ego. Let them do something. You'll be amazed at how creative your partners will be. Count the cost. This is Jimmy Shea. Hey, he's going to be my fellow next year. He was my resident years ago, and he's published a number of really meaningful papers, but the first one that he ever did, I had this idea about osteochondral allograft in a military population. I said, Jimmy, if you want to do this, I want to do research. I said, all right, this is the project. This is impactful. This is important, interesting, and publishable, and it's doable, but you've got to do some work. And so he did it, and it's impossible to find these people. You think that just because we're in the military, we can just make a phone call, order everybody? It's hard research. These guys don't want to be found. It's really hard to find them. He found one guy in a trailer park in the middle of Missouri that got out of the military and didn't, there was no social security number. I mean, long story. He comes into my office about halfway through the project, and he goes, sir, can I just ask you a question? I go, yeah. He goes, I got to know this is going to be worth it at the end. I mean, this is work, sir. And I'm like, yeah, man, I get it. Not in a weakness way, not he needed to be hugged. He just had that realization that said, dude, this is hard. Is this worth it? Is this what it is? Because he's had no payback at this point. I go, Jimmy, I promise you, because I know who he is, I promise you, you see this through and it will change you about what you do. And he did. You see this, AJSM, his first impactful paper, and it gets accepted to Academy, okay? And the session that it gets accepted to, he gets put on an expert panel with Bill Bugbee, who invented the allograft oats. Next to him is Tom Minus, who's the inventor of the ACI procedure, and Jimmy Shehey, R2, Tripler Army Medical Center. And in the questions, they asked Bugbee, Bugbee, Bill Bugbee, Dr. Bugbee, your data disagrees with Dr. Shehey. Can you explain the differences? And Bugbee says, he looked at it a little more closely than I did. Can you imagine? So here's Jimmy. He gets off. Everybody's watching him. He comes off the stage. His chest is out to about here as he comes off, and he goes, sir, what's the next project? It's a drug, man. You guys know. If you've published a paper, you know. There's nothing quite high like that. And so if you catch that, do it. Count the cost, though. Count the cost. So in conclusion, learn to be passionately curious. Hawk and I used to say this when we were interviewing our fellows. People would say, well, what is it to take to be a good fellow in your program? Passion and curiosity. I want you in hot pursuit. Now, here's the thing. You get to define what the pursuit is. I don't care. I've had fellows that are research juggernauts, and I've had fellows that are not going to do a lick of research, but they're passionate about something else. That's like catnip to us, right? It's unavoidable. Be passionately curious and be in hot pursuit. Learn to ask a really good question, okay? One that's interesting, answerable, and worth the effort. Now, worth the effort could be publishable, presentable, like Lake Louise, patentable. Many of those are good, but it's got to be valuable to put the time in. Put tools in your toolbox, right, that will be able to get you from idea to finish project. Find a team. Teams hold you accountable. Teams can be inspirational. Here's the best part about it. Teams develop deep friendships, because you know what? One of the deepest ways to form deep relationships is to work together. Hard work breeds this sort of relationship. Grill your idea. Get started on it early. Turn up the heat on it. Get the steak going on both sides, searing the juices, and then turn it down and let it simmer and procrastinate a little bit. Don't have to have it every night, all night, and be all that super productive. Get out of your lane and learn from other people in other disciplines. You'll be so enriched by it. The psychologists. I work with a chemist now. It's amazing the number of different fields, and they know so much about so many different things. Get out of your lane, please. It is absolutely worthy, and it's worth-filled work. So with that, I'll say thanks very much, and thanks for indulging me. Thank you.

importance of research

conducting research

good research question

challenges in research

curiosity in research

collaboration in research

mechanics of research