The Grauer Lab meets every Friday in an office suite of the orthopaedics department. Medical students, several residents, and a few attending physicians sit around the table, eyes fixed on a monitor at the front of the small conference room. They’re examining graphs and tables designed to explain the significance of medical data from thousands of patients across the country.
Lab members comb through national (sometimes Yale-specific) medical databases looking at outcomes of interest in the field of orthopaedics. By analyzing data from thousands of patients, they can gauge how well a treatment works; determine which conditions lead to surgical complications; and propose ways to optimize outcomes.
To come up with research ideas, the group reads through published studies and asks how the so-called big data approach might find better answers to existing questions. “We define questions raised from the literature or from local discussions and see what we have the tools to answer well. Often, we can resolve questions that have not been answered in the past, or use larger or more defined patient populations to address questions in novel ways,” said Jonathan N. Grauer, MD, interim chair and professor of orthopaedics and rehabilitation, and co-director of the Spine Center at Yale New Haven Hospital.
When Grauer joined the Yale faculty in 2003, he worked in a lab conducting preclinical animal studies focused on bone formation and spinal fusion. Over time his work evolved, and his research now relies on software and big data.
Grauer’s conversion to this type of research came in 2012 when a student approached him with an idea for a study. Rafael Buerba-Siller, MD ’14, MHS ’14, then a Yale medical student, asked Grauer whether he would be willing to help him apply big data research techniques to orthopaedics. Previously, Buerba-Siller had used such tools for studies in endocrine surgery. Grauer agreed to help: “And sure enough the study went great,” he said, opening “doors to novel approaches in orthopaedics and spine research.”
The focus of Grauer’s research shifted from gathering data to posing questions, assessing data, and deriving clinically useful conclusions. By applying contemporary clinical questions to big data sets, Grauer’s Lab performed more and more studies on varying topics in spine surgery and orthopaedics.
“I think [the lab] ranks pretty high in terms of productivity,” said Lee E. Rubin, MD, HS ’09, associate professor of orthopaedics and rehabilitation, who works with Grauer and helps guide the student members of the lab. He estimates that among the medical students who spend a full year of research in the Grauer Lab, “each will typically achieve 10 to 15 completed projects that are presented or published.”
Pat Bovonratwet, MD ’19, joined the Grauer lab in 2016 after his first year at Yale. “The upperclassmen had always told me, ‘Dr. Grauer’s the man to go to if you’re interested in orthopaedic research,’ ” he said. At the end of that summer, Bovonratwet published his first first-author paper. Since then, he has published a total of 33 peer-reviewed papers from the Grauer Lab. Bovonratwet is listed as first author on 14 of those papers.
This level of achievement is not unusual among the students in the Grauer Lab. “He’s very inclusive of medical students,” said Bovonratwet. “When I first joined, he told me, ‘I will always support you and your co-students in leading the studies.’ ” Grauer gives the medical students autonomy when it comes to research, guiding them at each step of the research process, and “helping them to develop their researcher skills,” Grauer said.
The lab is focused on making a clinical difference. “We review these projects at every stage,” said Rubin. “Almost all of these publications find a way in [to journals] because it’s high-quality research.”
Part of the reason the lab can boast this high quality is that its members scrutinize the limitations of their methods. “We’ve written many papers that call out the limitations of the type of research we do,” said Grauer. “In doing so, we become credible in the conclusions that we draw.”
According to Bovonratwet, aside from the research experience, lab members also benefit from a dedicated mentor and a network of lab alumni. Bovonratwet noted that many of Grauer’s previous lab members still remain involved, giving current members guidance, resources, or project ideas. This network is derived from Grauer’s dedication to research and his group. “He is a great mentor and supports his students through medical school and beyond,” said Bovonratwet.