Should I do research? Five commonly asked questions

When I came into residency, I had zero interest in doing research.  I thought it was boring, a waste of time, and (honestly) just not enjoyable.  I had been involved in some basic science chemistry research in undergrad for a summer doing gas chromatography.  It was as fun as it sounds (not fun).  To pad my CV in medical school, I once again decided to do research. This time it was clinical research, but the project never took off during the summer I had available to do the research because it didn’t get through the infamous “IRB process.”  [I later found out that the attending who was the principal investigator just filled the paperwork out late].

Bocce Ball
Getting your name on a paper is a bit of a game. Not quite as fun as Bocce Ball, but knowing the rules is required for both games!

 

With those experiences behind me, the interest in research just wasn’t there for me.  Well, that was until I was doing some reading when I was on call in residency on some regional anesthesia topics.  As I read, I realized that there were a few questions that hadn’t been answered adequately.  As a CA-2 (PGY-3) anesthesia resident I started designing a couple of RCT’s.  A few years later I finished them and they have been accepted for publication.  It also pushed me towards a career in academic anesthesiology.

 

Given that I had the experience of thinking research was pretty worthless and then the transition to “seeing the light,” I wanted to spend some time answering five questions that medical students often ask me:

1. Do I need to do research for “x” residency?

The answer to this question is a two part answer, but both can be answered from the same document.  The NRMP Charting Outcomes of the Match (This is the allopathic PDF, there are also osteopathic and IMG PDF‘s) data comes out every two years and shows you what the applicants applying into each specialty for residency look like, and how you measure up.

First Part: How strong is your application?

Based on the NRMP documents (and discussions with the PD for your intended residency program at your hospital), you can determine how competitive you are.  The less competitive you are, the more likely it is that research will help you. For example, in anesthesiology the average Step 1 score for matched applicants is 232, Step 2 was 242.

If you are a standard deviation (about 20 points) below these averages, then that means you are in the bottom 15% of applicants and have your work cut out for you.  You need to pad your CV  to give yourself a good shot at successfully matching.  Could you match without doing that?  Absolutely, but why take the risk.

If you look at the NRMP data closely, you’ll also see the average number of publications/posters/abstracts was 3 and 1/2.  So, if your Step scores are low, then you may want to aim for having above average in this category and get 5.  This helps make up for the deficit.  Of course, your letters of recommendation are likely to have the highest impact, but we will discuss LOR’s in another post sometime.

Second part: Do applicants in my intended specialty do a lot of research?

Again, utilizing the NRMP data you can see that not all specialties are the same.  I’ve given you some of the information for anesthesiology above.  Let’s take a look at another more heavily research-based specialty, dermatology, where the average number of publications/posters/abstracts is almost TWELVE. That is three fold more than anesthesia.  So, regardless of your competitiveness with Step scores, medical school, and LOR… you need to do research in this specialty.

2. How do I get started? Setting Expectations.

If you have answered either question above with a “maybe” or “yes” this part will discuss how to get started.  The first step is to find someone to work with.  Many medical schools have medical student research programs to help facilitate medical student research.  If not, asking the residency program director or associate program director for names of people in the department that do research is a helpful place to start.  Ask about current projects and find something that both suits your interest and your aims (to get a poster, publication, or abstract).

After you determine the person you are going to work with, the next thing to do is to set up a meeting where expectations can be clearly stated.  I cannot overemphasize how important it is that everyone is on the same page from the onset of a project.  If you expect a first authorship out of the project, and you are only acknowledged (not an author) on the paper, you’ll be upset. [More to follow on authorship below]. Set expectations.  It’s that important.

3. Who should I work with?

I think this is the simplest question to answer.  After you’ve met with the various names found in the step above and laid out expectations, you need to work on the project that 1) interests you the most and 2) will allow you to get publications, abstracts, or posters out of it.

It doesn’t matter if the person is a PhD, MD, Assistant Professor, etc.  The most important thing is to accomplish getting started in something that interests you and will get your name on something.  Interest is important because you will be more likely to work hard (and likely get a LOR out of it).

Of course, if all things are equal, go with the person who is more recognizable in your chosen field.  However, this is definitely secondary to accomplishing points 1) and 2) above.

4. Will I get published?

The sage advice given above cannot be overstated.  Make your expectations clear from the onset!  That said, there are pretty clear guidelines for who is and is not an author.  This can be found in the International Committee of Medical Journal Editors (ICMJE) guidelines:

The road to publication can be a long one. Get involved in projects with opportunities for posters, abstracts, and (maybe) a publication!
  1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
  2. Drafting the work or revising it critically for important intellectual content; AND
  3. Final approval of the version to be published; AND
  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

In order to qualify for authorship, you have to meet all four of the above criteria.  That said, if you meet some of the above contributions (do not meet all four), you will usually receive what is called an “acknowledgement” at the end of the paper stating, “We would like to thank John Smith for collecting data for our study.”

The reason the author guidelines are important is that every author is vouching for the validity of the paper being published.  If it gets redacted (a BIG deal) you are also agreeing to accept that responsibility!

5. What is the best kind of publication to get my name on?

The simple answer to this question is: Anything you can get your name on is a good thing.  Of course, the best possible thing would be to get your name on a multi-center randomized control trial… but that is highly unlikely to happen as a student. You’ll note that the above NRMP data breaks things up into “abstracts, presentations, and publications.”  So, anything in this realm is a good thing.

Abstracts and presentations can really be accomplished from any kind of study.  Presenting an abstract for a case report (difficult/rare patient) is easily done at most national conferences.  Presentations can be made on completed studies that have not been published yet in a medical journal, which is a great way to both present at a meeting and get your name on a poster.  Publication in a journal usually takes months from the time of original submission, which may mean that you cannot add this to your CV before you apply!

As for publications, the easiest type of publication to land your name on is a retrospective chart review.  This is for multiple reasons: 1) It can be finished and published in time course of your training, 2) the majority of the data collection and analysis can be performed by the student, which means you had a major contribution and warrant being an author.

Regardless, getting your name on anything shows effort and accomplishment.  Fret less about what your name is on and focus more on simply getting involved in relevant topics to your anticipated field!

What do you think?  Do you make your expectations clear prior to starting a project?  Did you do research in medical school prior to applying?  What’s your advice for this common question?

TPP

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