Advancing research through team science: A conversation with David Morgenroth, MD
Professor David Morgenroth, MD, vice chair for research in the Department of Rehabilitation Medicine at the University of Washington School of Medicine, joins this episode to talk about his path in academic medicine and his approach to research leadership. The discussion explores collaboration across disciplines, long-term research impact, and how the department supports mentorship and innovation.
Watch the video to learn more, or follow along with the transcript below.
Video Transcript
Team science is really the name of the game. The idea was to say how can we advance research? Take an already strong research enterprise in the department and make it even stronger.
Melinda Johnston: Hello, and welcome. I'm here today with Professor David Morgenroth. He is the vice chair of the Department of Rehabilitation Medicine here at the University of Washington School of Medicine. My name is Melinda Johnston, and we're going to learn a little bit more about how research works here in the department.
Dr. Morgenroth, why don't you tell us a little bit about your career to date and how it has brought you here to UW Medicine as vice chair of research?
Dr. David Morgenroth: Okay, well, first of all, thank you for having me. Melinda, nice to be here with you. I know we have limited time, but I'm going to start back, as a kid, and I was always interested in science growing up, and I actually went to college thinking I was going to be an engineer, and that I was going to design mountain bikes. But that quickly changed as I was in college, and there were a few courses in particular that led me in the direction of medicine.
One was a human anatomy course, where I really was enthralled by studying the human body. And actually, an American history course that was very focused on stories of human experience and challenges within these stories of human experience, and how people have overcome those challenges. And I think those two concepts together—the human body and the human experience—led me in the direction of medicine.
And then at the same time, I serendipitously found my way into working in a biomechanics lab, studying, walking, hopping, and jumping, which were intriguing intellectually. And as someone who is a basketball player, it really appealed to me what I was doing athletically as well. And so I think those planted the seeds of really serious science because I was working with some exceptional mentors.
Then, fast forward to medical school—and as a matter of fact, before medical school, I took a detour. And because I come from a family of teachers, I was a sixth-grade math and science teacher in New York City, where I'm from. I think that also led in this direction of academic medicine, where I would be doing research and teaching as well as clinical care.
So, in medical school I obviously found physical medicine and rehabilitation, which was a field that really appealed to me intellectually as far as my interest in neuromusculoskeletal physiology and pathology, but it also appealed to me sort of holistically and philosophically.
The next good step in the story was finding my way to the University of Washington. As a New Yorker, it wasn't an obvious choice. But I had gone to college in California, so I had done a stint out West for four years at UC Berkeley and then been back in New York for teaching, medical school, and some other things.
I thought, well, I'd be open to being back out West for another adventure for three years because that's how long residency is. But I chose it because obviously it's a beautiful part of the country. But also, the program is just exceptional. And it was really about the people that were here, and very smart, caring colleagues, teachers, and folks that I wanted to learn from. It was just a top-notch program.
So, I found my way here, thinking I'm going back to New York as a New Yorker after this is done. Now, of course, it's 20, 22, or so years later, and here I am. There are many reasons to stay.
As I moved from being a resident and a trainee here to joining faculty, it's really inspiring during the training phase, by Dr. Joe Czerniecki, who became my mentor. He is both an exceptional clinician, seeing patients primarily with limb loss, but also, just a great scientist, and what became clear was that he is also a great teacher and mentor.
Working with him, and through the Rehabilitation Medicine Scientist Training Program nationally, where I had mentors like Mike Boninger, who were real national leaders, I really dove into the science side of things. While I was seeing patients, I was also building a research program through this mentorship.
Over the years, building a research program, I began to get more and more interested in: how can I help others? How can I give back? Both through mentorship, through teaching, but also thinking about systems-wide, how can we improve research across the system? How can we help our researchers thrive here?
Between thinking about that and being involved in some national leadership through the Association of Academic Physiatrists, it got me really interested more and more in leadership and seeing other great leaders nationally and learning from them. It led eventually to becoming vice chair for research in the department here back in 2020.
Johnston: Wow. That is quite a journey. And I think your story of being interested in so many disciplines and so many influences on your journey really reflects this department, which is big and complicated and encompasses many specialties. So, how does that work for our department to have so many different groups under the umbrella of rehab medicine, all working on research?
Dr. Morgenroth: Yeah, it's a great question. And, to go into a little more detail for those who may be less familiar.
We not only have different professional divisions, such as the physicians (physiatrists), rehabilitation psychologists, physical therapy, occupational therapy, prosthetics and orthotics, and a rehabilitation science PhD program, but amongst all of those divisions, we have scientists and clinician-scientists who have expertise in different scientific domains. And these could be things like biomechanics, which is what I studied, epidemiology, and health services research. And there are many more.
We also have people who have a focus on different individual patient populations within rehabilitation. So, whether it's folks with limb loss, people with multiple sclerosis, or other types of neurologic disorders such as stroke, spinal cord injury, or traumatic brain injury. So, you take all of that. And, then we also have dispersed sites. Of course, we have the University of Washington, Harborview, the VA, Seattle Children's. There are a lot of different domains there to figure out how to bring this together towards one enterprise.
I think the answer is that team science is really the name of the game. There can be exceptional individual researchers. But when we bring people together from different disciplines, different scientific domain expertise, that's where we get to think in really innovative terms and where I think we can have the greatest impact with the research we do.
We really try to foster an environment where it's ripe for collaboration across divisions, across scientific domains, and outside of the department as well, so that we can bring together teams that break down some of these silos to try and produce the most innovative and impactful research that we can here.
Johnston: Wow. That is, oh, that's a lot. But speaking of impact and also of bringing people together, I know that, a few years ago, you led a research strategic plan to try to get grips on this enterprise. So, what did that process teach you? And what are our priorities now in terms of the strategic plan?
Dr. Morgenroth: Yeah. And I think strategic planning is an important means to not just allow momentum to carry you, because there's a lot of momentum in health care and science. And if you allow momentum to carry you without taking a step back and really trying to say, “Where are we now? Where do we want to go?” then you tend to just let the winds that blow drive you in whatever direction they will. Sometimes that's fine. But it became clear that it was important for us to say: we're doing a lot of great things, but we can be doing even better.
So that strategic planning process started in 2021. The idea was to say: how can we advance research, take an already strong, research enterprise in the department and make it even stronger? How can we improve the impact we have on the patients that we serve? But also, how can we help our researchers thrive? How can we help our trainees become successful researchers or clinician scientists?
The approach we took was a very collaborative approach. The idea being that if you try and take a top-down approach, people are not going to buy in—faculty, students, staff—they're not going to buy into that. So, we really wanted to do this from the bottom up, in more grassroots way.
The first step, as I was leading this, was to say, it can't just be me, or it can't just be the department chair and me. It has to be representative of all the stakeholders across the department. So, we brought together a research steering committee that was representative of multiple groups across the department.
We also hired a strategic planning consultant because I didn't have a background in strategic planning. While we in the department are the content experts, this strategic planning consultant was the process expert. And he was fabulous to work with. I learned a ton from him about strategic planning. What that enabled us to do is say, “okay, what do we need to do to really engage all these stakeholders?”
And so, in addition to that research steering committee, we also had two retreats where we invited about 40 to 50 folks from across the department. Again, this is faculty, trainees, staff from across the department, together for half to full-day retreats. At the retreats we were, first of all, figuring out how do we best assess our current state. What are our strengths? What are our limitations? But then also, how do we envision the future? How do we go from there and say: let's build on those strengths, let's overcome those limitations. Also, let’s think outside of the box and let's think in an innovative manner so that we can move strategies and tactics forward that are going to take us to a new level.
Just to give an example, I think some of the focus areas that we really honed in on were things like: how do we improve mentorship to ensure that we're raising all boats? It's not just the people who happen to already have good mentorship. It’s that we can take all of our trainees and our junior faculty and really mentor them to the best of our ability.
Another example would be: how do we create a greater impact with our research? There's plenty of research that builds over time. But how do we take it to clinical translation as best we can, so that the whole goal of improving the care of the patients that we serve becomes closer? How do we do that to a better extent? And there were other aspects like improving the collaborative culture and opportunities for collaboration.
Johnston: Wow. That's fantastic. And I think just to ground that a little bit, I know one example of long-term research that has really shown results for patients is the work of Professor Dan Norvell. Perhaps you could explain that as just one example of what you're talking about.
Dr. Morgenroth: Yeah. And Dr. Norvell is a fantastic scientist. I think he would be the first to say that he is part of a team of transdisciplinary or interdisciplinary scientists that have come together to build this whole line of research.
Dan is an epidemiologist with a PT background. Part of that team includes physician scientists, physiatrists, prosthetist‑orthotist scientists. And I'll tell you in a second why that's important. You know, folks within other realms as well, because building into the electronic medical record system takes other expertise, implementation scientists, things of that nature.
What Dan and team really have been working towards for many years is: how do we improve care for people with limb loss starting before they actually get an amputation? The idea being that it's a really complex decision when you have someone with a lower extremity disease process, such as diabetes and vascular disease, that impairs the health of their limb and can lead to ulceration and amputation as an example.
But then once that occurs, how do you decide what the optimal amputation level is going to be? Is it going to be through the foot? Is it going to be below the knee, above the knee? And there are advantages and disadvantages to each. And it's clearly a huge decision. You can imagine, for a patient who's about to undergo this it is hugely complicated but also complicated for the clinicians.
The idea of Dan and his team was to say, let's take an evidence-based approach. They built a predictive model to say: we want to understand if you undergo an amputation at these different levels, how is that going to affect the potential for regaining a certain baseline level of mobility? The likelihood of re-amputation—because obviously, that's not something you want—and the mortality rate as well. You have to put those together and think about them in terms of the patient's priorities to come up with a decision. Ideally that's a decision made between the clinician and the patient. And so, putting that from a predictive model into a decision support tool enables, I think, more of an evidence-based conversation that leads to better outcomes. It's truer to patient priorities.
Johnston: Well, the amount of science and the length of time—I know his studies have gone on for quite a while, perhaps over a decade—to bring this much science, evidence, different disciplines, together into it. The website is beautiful, we’ll link to it, where someone can walk through the decisions to try to help them and their doctor make these decisions. It's just one example of the many patient impacts.
Dr. Morgenroth: And, you know, I think the impact is clear. This has been used. It's called AMPREDICT, and it's been used by thousands of clinicians, I think, across 80 or so countries around the world. So, this is a great example.
It's not by any means the only example here. We have many great examples of researchers doing innovative research that have led to improved clinical care. But that's the idea. You take something from discovery all the way through clinical translation, where you're actually benefiting patients over time. And, that's really the goal for all of us.
Johnston: That's amazing. And actually, that journey of starting and working through to implementation gets back to a point I was going to ask you for more information on, and that's how we take new scientists, people newly embarked on this journey, to get them to the point where they are career scientists at the stature of so many in our department. I know you've been doing a lot of work around that area.
Dr. Morgenroth: Yes. It's always been hard to really embark on a career that involves a significant amount of research. You know, learning grant writing and then getting grants funded, getting manuscripts published in high enough quality journals, and thinking in a visionary term, it takes a lot more than just learning the science itself. It's also learning how to navigate the world of science.
Mentorship is absolutely vital. It's been vital in my career, as I mentioned earlier. And so, as part of the strategic planning process, this was a key focus area. One of the key focus areas is saying, well, how can we ensure that we're giving optimal mentorship to the folks who want to do science as a significant aspect, whether they're clinician scientists or pure researchers?
There are two programs in particular, I think, that are worth highlighting. These I co-lead with Dawn Ehde, who's our vice chair for faculty development, who I think you'll be interviewing for another one of these podcasts at some point.
Johnston: Absolutely. We will. Yes.
Dr. Morgenroth: That’ll be great to hear from Dr. Ehde. The two programs that we're co-leading, one is a more sort of formalized research mentorship program, with the idea being we don't want to just leave it up to junior faculty to try and just figure out who might be a good mentor. We want to help guide that process. We want to help ensure that there's optimal mentorship. So, that means that we're looking for mentorship teams for each individual, a primary mentor and a secondary mentor to offer different perspectives and build in a plan that can be worked on over time, starting with what the mentee actually is thinking for their career, and with a lot of feedback and regular meetings with the mentors.
We track all of our junior faculty in the areas of research and clinician scientists, and try to ensure that they have those mentorship teams and that, over time, those are working well.
The second program is called Springboard to Success, which is a program once a month where we have mostly junior faculty, but a bunch of the senior faculty come, and we discuss a specific topic within research. So, it might be manuscript writing or grant writing, or how to do a grant review, or how to think about collaboration, or how to think about visioning for scientific pursuit. And, we'll come together and discuss that. And the idea is that we're not only hopefully imparting some wisdom from the senior folks to the junior folks, but that the senior folks can also learn from the junior folks. And we're building community, which is a key part of it all.
Johnston: That's a fantastic tool. And I know too, our department, since we have academic programs, we have people who've started as an OT or PT, and who move into our PhD in rehabilitation science, and have moved on to faculty and are now researching some very exciting innovations. So, clearly something is, something is working in that pathway.
Dr. Morgenroth: Yeah.
Johnston: Well, thank you so much, David. This is a huge topic. And we could certainly have examples from our department all day. But we'll be back with further episodes. But I did want to ask you a kind of personal question.
We've heard a little bit about how big this department is and certainly how big our research enterprise is. It's a big job. And you also have clinical duties. What motivates you every day to come in and do this difficult job? Challenging times? Difficult work?
Dr. Morgenroth: I think the simplest way to answer that is it's about the people. And I mean that in a kind of global sense. It's about my colleagues that are, you know, really motivating me every day and, you know, caring, smart people that I get to collaborate with. I get to mentor, I get to teach, I get to learn from, and they keep me on my toes. How can we improve upon things every day? And it's about the patients as well. And I mean that both in terms of the patients I'm seeing directly in clinic that I'm trying to help as individuals, but also thinking about how we can improve the care of these folks from a systems level on the leadership side. From the scientific pursuit of thinking about better ways that we can care for people, or ways to help them thrive.
I found out about myself, I'm a relationship-driven person. I think that's what really keeps me motivated, keeps me feeling satisfied with this job. I’m doing all these different things, but it's all geared towards the people.
Johnston: That's fantastic. And I must say, working here, the people of this department are fantastic and a truly amazing group of people. Well. Thank you so much, Dr. Morgenroth. It's been a pleasure speaking with you today, and I'm sure we'll chat again.
Dr. Morgenroth: It's my pleasure, Melinda. Thank you. Thank you so much.