Is clinical research incompatible with what adcomms look for in research?

[bluestrawberries]

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I know in clinical research the hypothesis and experimental design is usually set in stone by the pharmaceutical company well before any student researcher comes along. I have heard that medical schools generally look for research where the student was in charge of a hypothesis driven project and actually has some legitimate creative input. So by default, that is not allowed in clinical research. Does clinical research "count" then for admissions purposes? If one is still able to explain the hypothesis and data analysis in the application will it benefit the applicant for that area of the application?

 

[piii]

Lots of false assumptions and weird deductions here. Yes it counts

 

[mimelim]

I know in clinical research the hypothesis and experimental design is usually set in stone by the pharmaceutical company well before any student researcher comes along. I have heard that medical schools generally look for research where the student was in charge of a hypothesis driven project and actually has some legitimate creative input. So by default, that is not allowed in clinical research. Does clinical research "count" then for admissions purposes? If one is still able to explain the hypothesis and data analysis in the application will it benefit the applicant for that area of the application?

I don't think you know what clinical research is. Which is fine, but for clarification purposes...

Clinical research is performed by many different entities, including every academic and many private institutes. For example, we as an academic vascular surgery department have a very robust clinical research group. We produce a dozen or so papers a year and maybe a hundred or so presentations/abstracts. In the last year, I have had 8 students work with me. They vary from 3rd year medical students all the way down to high school graduates about to start pre-med (over the summer). My general expectation is that they will help with the on going projects, but if they find something that they want to focus on or there is something small that they can take ownership of, they will do it. To this end, every student gets assigned a case report to write up. While not all of them go to publication, some have. Virtually every student that has spent time with us has published. Some have first authorship. All have opportunities to present locally and one is actually presenting at our national meeting in March. You bet that he had massive amounts of creative input on that project.

The reality is that the vast majority of medical school applicants do not have substantive research. They don't design projects, they don't derive hypothesis, they don't get funding, etc etc. Which is completely and totally fine. Medical schools are NOT trying to train researchers. They are trying to train physicians, some of whom may end up doing research (sometimes a lot of). Applicants with publications are rarer than people think. Applicants with strong research experience is even fewer (publication doesn't mean a ton by itself). By the same token, a fundamental understanding of the research process goes a long way. Being able to read papers, being able to appreciate the nuances of setting up a project or study, being able to understand basic statistical methodology is all incredibly valuable to a pure clinician. Thus, medical schools value research experience, even if it isn't a massive undertaking. You get this from clinical research just as well as anything else.

To answer your questions.
#1 Clinical research is perfectly fine for medical admissions and is many times preferred.
#2 If by "count" you mean adcoms see it as a positive, yes it "counts". But, overall using this methodology of what "counts" and what doesn't is a terrible way to go about an application.
#3 It doesn't mean a ton for someone to regurgitate the hypothesis and data analysis. Honestly, anyone reading your paper should be able to do that. When I interview people and I ask them about their research (which is every single applicant that I meet), I want to know their level of involvement and where that leaves them going forward. Do they have those basic skills? Were they a dish washer who read the paper? In simple terms, are they a better applicant for having those experiences. If the answer is yes, then it absolutely helps.

 

[Goro]

To follow up on my learned colleagues very wise words, med schools value that you know something about the scientific process. That means clinical research is fine. Basic research is fine. It doesn't matter whether it's on an oncogene pathway, data on the effects of salt intake on hyperneurotic pre-meds, or studying clams from Fiji.

 

[bluestrawberries]

It is rare to get a student who has worked in industry for a period of time; I did interview someone who worked in a clinical genetics lab after graduation (testing amniotic fluid, etc). I've also seen applications from students working in quality control in factories (e.g. testing consumer products for bacterial contamination) but the coin of the realm is hypothesis driven, systematic development of new knowledge. We do see many students who work at the NIH for a year or in an academic medical center research facility for a year or more after graduation. We do see some who work in clinical research but that is neither fish nor fowl: most of it is paper-pushing and interactions with subjects (who may or may not be patients as well) and very rarely do the local investigaors, let alone the local research assistants, have any say in the protocol development or the actual study design behind the clinical research.

While this is hypothesis driven, a research assistant has no say in the development of the hypothesis and in many cases the local PI has no input, either. Projects are put together by pharmaceutical companies or collaborative groups and sites, including investigators at academic medical centers, are recruited at as many as 100 different sites. A research assistant may have responsibility for one big study or may have many different studies each with a very small anticipated enrollment.

Is it research or is it clinical? If you are designing the research study, collecting and analyzing the data, I'd count it as research and count it heavily. If you are only interacting with sick people during a clinical encounter but the information you gather is used for research, then it is more on the clinical side, imho. So, you might be consenting patients, measuring vital signs, providing instructions on how to collect a urine sample and directing the subject to the restroom, preparing samples for shipment, filing paperwork.... that isn't research so much as clinical.

My biased opinion would be TB work. Might it be possible to get a publication out of that? Two experiences abroad in different countries with different populations would make you a strong applicant with a focus rather than making it appear that you checked the international box, then checked the clinical coordinator box, etc.

Clinical research stateside is often dictated by sponsors (big pharma) and there is very little intellectual investment by the local "investigator" (aka "study doctor") and little say in how the study is run or how the data is analyzed and released.

If you had to answer a question about what you would do if medicine were not an option (alternate career) would it be research coordinator stateside or international public health worker?

Clinical research protocols are generally locked in before research assistants come on board and have a chance to provide creative input.What you didn't mention, and what will get you more points during interviews, is that you understand the hypothesis that's being tested and have a knowledge of the past publications upon which your research is based. If you haven't, consider asking for and reading the original grant proposal, which should provide all the context you need. I agree with referee3 that publications among med school applicants are rare, and you won't suffer for the lack of one. If you can get a poster out of it, that would be good, though.

2) Sounds like a bad idea, considering the hours that two lab courses will consume.

You need to be able to speak knowledgeably about hypothesis-driven research and describe your role in the process.
How are hypotheses developed?
What kinds of studies can be designed to support or refute the hypothesis?
How are results analyzed?
What are the clinical implications of the possible outcomes...

This is one of those "neither fish nor fowl" situations. If the research subjects are not sick, then they aren't really even patients. Drawing blood, processing samples is an interesting skill and the interactions with subjects in setting them at ease, informing them and answering their questions before obtaining their consent to proceed, and collecting data from them, is intersting but it is hard to decide if it is clinical (because the subjects are not "patients") or research (because you have no role in study design or analysis). You may have developed useful skills and this may have sparked an interest in clinical research and you can play that up in your application but I would not suggest that this should substitute for "research" or for clinical exposure.

Another few posts by LizzyM:
Clinical research is good. Most of the time a pre-med college student or new grad's involvement is not at an intellectual level that is any higher than a lab tech in bench research (you aren't coming up with hypotheses and designing experiments to test those hypothesis but rather carrying out instructions put together by others). That said, interacting with subjects and potential subjects can help you develop useful skills you can't develop at the bench.
Ask your PI to share with you some of the published research in the topic area you are working on. Where are those papers coming from? That may give you an idea of schools that would be receptive to the skills you bring.

It is rare to see someone at the undergrad level who is doing the intellectual work involved in a clinical research study whereas it is possible to see that in bench research. Even seasoned attendings on the medical school faculty are often passive receivers of protocols written by sponsors of the research. There is some judgment on the part of attendings who conduct clinical research under those circumstances (assessment of side effects, decisions regarding dose escalation in light of side effects, symptom management, and so forth) but that is beyond the capacity of an undergrad.
When I do see someone who has not yet completed college doing clinical research it is often an unsophisticated "medical record review" (e.g. a look through the records in dad's pediatric practice to determine the proportion of kids who got flu vaccines last season stratified by chronic condition) that may be more "quality assurance" than "research" as it is often not generalizable new knowledge.

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I don't think you know what clinical research is. Which is fine, but for clarification purposes...

Clinical research is performed by many different entities, including every academic and many private institutes. For example, we as an academic vascular surgery department have a very robust clinical research group. We produce a dozen or so papers a year and maybe a hundred or so presentations/abstracts. In the last year, I have had 8 students work with me. They vary from 3rd year medical students all the way down to high school graduates about to start pre-med (over the summer). My general expectation is that they will help with the on going projects, but if they find something that they want to focus on or there is something small that they can take ownership of, they will do it. To this end, every student gets assigned a case report to write up. While not all of them go to publication, some have. Virtually every student that has spent time with us has published. Some have first authorship. All have opportunities to present locally and one is actually presenting at our national meeting in March. You bet that he had massive amounts of creative input on that project.

The reality is that the vast majority of medical school applicants do not have substantive research. They don't design projects, they don't derive hypothesis, they don't get funding, etc etc. Which is completely and totally fine. Medical schools are NOT trying to train researchers. They are trying to train physicians, some of whom may end up doing research (sometimes a lot of). Applicants with publications are rarer than people think. Applicants with strong research experience is even fewer (publication doesn't mean a ton by itself). By the same token, a fundamental understanding of the research process goes a long way. Being able to read papers, being able to appreciate the nuances of setting up a project or study, being able to understand basic statistical methodology is all incredibly valuable to a pure clinician. Thus, medical schools value research experience, even if it isn't a massive undertaking. You get this from clinical research just as well as anything else.

To answer your questions.
#1 Clinical research is perfectly fine for medical admissions and is many times preferred.
#2 If by "count" you mean adcoms see it as a positive, yes it "counts". But, overall using this methodology of what "counts" and what doesn't is a terrible way to go about an application.
#3 It doesn't mean a ton for someone to regurgitate the hypothesis and data analysis. Honestly, anyone reading your paper should be able to do that. When I interview people and I ask them about their research (which is every single applicant that I meet), I want to know their level of involvement and where that leaves them going forward. Do they have those basic skills? Were they a dish washer who read the paper? In simple terms, are they a better applicant for having those experiences. If the answer is yes, then it absolutely helps.

Sorry if I misunderstood. I guess I was mainly referring to the clinical research where only a clinical trial is involved?

I tried to look this up on SDN before and most of my understanding came from the above posts from LizzyM, gyngyn, and Catalystik where I got the impression that research only significantly added to an application where there was an independent project involved (easier to do with bench research). When I tried to look for research opportunities at my local SOMs a lot of MD physicians conducting research had a clinical trial listed on their page so I assumed that if I chose this route I most likely would be working with a physician PI for a clinical trial.

Regarding the bolded, I don't have research experience so I'm willing to try it out for a year or so. I'm looking forward to it as a learning experience. Though I do know it is something most schools consider as part of their criteria so whether I pursue research in my professional career or not I do want to do something that will at least "count" for medical school admissions purposes since it seems that almost all schools look for it.

 

[mimelim]

Sorry if I misunderstood. I guess I was mainly referring to the clinical research that's produced where only a clinical trial is involved?

My understanding came from the above posts from LizzyM, gyngyn, and Catalystik where I got the impression that research only significantly added to an application where there was an independent project involved (easier to do with bench research). When I tried to look for research opportunities at my local SOMs a lot of MD physicians conducting research had a clinical trial listed on their page so I assumed that if I chose this route I most likely would be working with a physician PI for a clinical trial.

Clinical research is not the same as a clinical trial. Clinical trials are the tip top of the evidence pyramid in our world. They are extremely time consuming. They are difficult to establish. They often require funding. They require organization and a tremendous amount of administration. I know because I am now a PI on two RCTs (launched on Monday!) and the amount of effort that went into dotting the i's and crossing the t's was higher than anything I have ever done before. In short, they are not something that a student is going to be involved in from a 'research' side. They are something that they may work on as a coordinator or as a research assistant etc. But, that is not doing research. That is working, which is I think what LizzyM and others are saying is not particularly helpful in admissions. (which I agree with entirely). It is hard without context for their posts, but I also think that LizzyM and others are under appreciating other facets of clinical research.

In many fields, including mine, very little of what we do is based on RCTs. Most of it is based on retrospective analysis and a lot of it is based on 'expert opinion', which is basically our national society setting guidelines. A 30 patient case series is sometimes THE authority on a particular pathology/operation. Is it weak evidence? Absolutely. But, sometimes it is impossible administratively, ethically, morally or financially to run a trial, especially in surgery. I certainly appreciate the dig, "is often an unsophisticated "medical record review" (e.g. a look through the records in dad's pediatric practice to determine the proportion of kids who got flu vaccines last season stratified by chronic condition)". While this may be true, this is how a lot of real research is started. Of the 8 investigator initiated trials we are running here, 7 of them were structured based on retrospective analysis generated by students/resident tabulating charts. There is little educational/experiential benefit from sitting in a room reading charts. But, going through that process of figuring out what is worth gathering data on, gathering the data, analyzing the data, doing the statistics, writing and publishing is all very valuable for trainees.

I'm going to batsignal @LizzyM because I'd love some additional commentary. I really think that we are saying the same things and have very similar opinions on this topic. But, as with everything, the devil is in the details.

 

[LizzyM]

I know in clinical research the hypothesis and experimental design is usually set in stone by the pharmaceutical company well before any student researcher comes along. I have heard that medical schools generally look for research where the student was in charge of a hypothesis driven project and actually has some legitimate creative input. So by default, that is not allowed in clinical research. Does clinical research "count" then for admissions purposes? If one is still able to explain the hypothesis and data analysis in the application will it benefit the applicant for that area of the application?

I guess it depends on your career goals, the schools you are targeting, and what you mean by "count", and what you mean by "clinical research". As mimelim points out, there are investigations taking place in clinical settings that do give young investigators the opportunity to be involved intellectually. On the other hand, I have seen clinical trials, in particular, as well as some large prospective cohort studies, where a research assistant is merely answering phones, handling paperwork, and perhaps, packaging samples of shipping. You really need to know the job duties to determine if this is really "scientific" or more "clerical".
Some schools are aiming to educate the next generation of physician-scholars and do highly value research experience, particularly hypothesis driven investigations and the development of bench skills.

 

[Goro]

Just to follow up on my learned colleagues' very wise words again, if you're in the lab of your PI, and looking at biomarker levels of, say, CRP in condition X, and the effect of intervention on said CRP levels, then you're doing clinical research. And it doesn't even have to be at the level of an intervention, it could a fishing expedition, look at at levels of something only. A lot of findings come out this way.