Resident research and publishing

deschutes · May 30, 2007

Okay, so this is what I'm picking up about research in residency that nobody told me about as I hurtle towards another July 1st:

Leaving academics and high-power mudphud talk out of the question + grossly oversimplifying the issue + adding a splash of whine, the objective of undertaking research projects during residency is to get yourself a fellowship.

Therefore, a publication has to come out of the research project by the beginning of the fellowship application process so that you can put it on your CV, since everyone knows that too many abstracts and not enough publishing spoils the broth.

It follows then, that the ideal resident research project is.... a case report???

Sigh.

Thaitanium · May 30, 2007

I don't see how many residents can publish a full-fledged, first author article while in residency. How many months are you given to do research? Research can take up to 6 months-1 year to publish. Add in the time to write up a manuscript in addition to data collection and the time spent to revise manuscripts it can be a long and tedious process!

l&usibari · May 30, 2007

Thaitanium said:
I don't see how many residents can publish a full-fledged, first author article while in residency. How many months are you given to do research? Research can take up to 6 months-1 year to publish. Add in the time to write up a manuscript in addition to data collection and the time spent to revise manuscripts it can be a long and tedious process!

I dunno, I managed to do it in my 2nd year. It was a pain in the ass and did take months, including working evenings and coming in on weekends, but I got it published, and it wasn't just a case report. Does that make me stellar? I sure hope so.

deleted113029 · May 30, 2007

lusibari said:
I dunno, I managed to do it in my 2nd year. It was a pain in the ass and did take months, including working evenings and coming in on weekends, but I got it published, and it wasn't just a case report. Does that make me stellar? I sure hope so.

I take it you were on CP for those research months.

fatboy · May 30, 2007

lusibari said:
I dunno, I managed to do it in my 2nd year. It was a pain in the ass and did take months, including working evenings and coming in on weekends, but I got it published, and it wasn't just a case report. Does that make me stellar? I sure hope so.

Maybe this is an easy question, but does research from med school published DURING residency count toward fellowship applications? For example if they're published in 2007/2008, will it still look "fresh" when I apply for fellowships in 2009/2010? I'm hoping that I can focus more on path training in residency (rather than jump into a lot of projects) and still be competitive for fellowships.

Mindy · May 30, 2007

Publishing is not that hard. I published 7 during residency, and 2 during med school. I have 2 manuscripts just waiting for boards to be over with to complete. Some were little ditties, others more substantial. Here's my (non-PhD) approach:

1) Find an attending who already has an idea, i.e. "Hey look, I've collected 100 cases of X and always wanted to stain them for Y."

2) Develop a hypothesis. Whatever question you are asking needs to have a yes or no answer essentially, i.e. "Does lesion X stain more diffusely for impox Y than its normal counterpart?" DO NOT pick an ambiguous hypothesis. DO NOT choose a project without a well defined end point. This is very important so that you do not drag on forever with your work.

3) Pick your methods, your (statistical) analytic and grading schema, and your conclusions based on your findings. For instance, if the lesion is more positive for Y than normal, then [insert conclusion A here], or, if the lesion has the same positivity as normal, then [insert conclusion B here].

3) Pick a target journal. Get a copy of the author guidelines and follow them to a tee. Write your manuscript exactly for that journal. Look at work that is similar in concept to yours to see how other authors tackled it.

3) Write the intro / methods as the work (e.g. impox) is being done. The intro in my opinion takes the most work.

4) Analyze your data. Use a statistician (which are often available at large universities) if you are uncomfortable with number crunching.

5) Plot your figures/graphs/charts from the data.

6) Summarize your results from the figures of your data for the manuscript. I think that the entire results section works best if done AFTER you do your figures/tables.

7) Write the discussion /conclusion. Be very careful not to make claims that are not actually supported by your data. Draw specific conclusions--as editors have repeatedly told me, drawing no definite conclusions from your work is bad.

8) Have all of your authors look at your (near-complete) first draft, make changes per their input.

9) Send your manuscript out either online or snail mail per the author's instructions. Wait several months for the revision (I did have 1 paper accepted "as is"), revise right away, and send it out again.

10) Rejected? Who cares, send it to the next bad boy (i.e. journal) in line. Remember, though, similar journals may use the same reviewer who rejected you the first time around. I have NEVER had a paper ultimately be rejected. I have had to journal shop to find a good home though 😉

Other bits of publishing advice: CP labs generate HUGE amounts of data, all for the publishing. Just ask around--someone's bound to have a half-finished project looking for a dedicated first author. Keep in mind, case reports are almost as much work as primary (clinical-oriented, don't want to peeve the PhDs!) research. I have published only one, I think, though I have published small case series. I think in rare entities, case reports can be very important. One paper I wrote specifically dealt with how to manage refractory TTP via a case description. TTP is a fairly rare and very often anectdotally treated condition. In fact, we "cured" this patient by using case report data for a fairly experimental approach as a guide, so felt it was important to add ours to the literature.

Finally, in regard to fellowships and research: I think that the resident who publishes (and is a good pathologist) will be considered a superior candidate to the resident who does not publish. Why? Salaries in academics are based on publication quantity. A fellow who pumps out papers for their attendings is a huge financial plus. A person with a track record for being able to publish and do their work during residency is ideal.

Mindy

Mindy · May 30, 2007

Oh yeah, and if ultimately you want to assure that you do get your project finished and published, keep as much absolute control over it as possible. YOU be the corresponding author (at least pre-publication).

Do not let it grow dust on someone's desk after you did all the work. Get their okay, and get the darn thing out the door...

Oh yeah, one more point, there is a paper to be made out of every collection of data. You just need to be creative enough to see the point of it all...

Wait, I guess I have one more point after that last one: Publication is communication. You do not know exactly how your work will be perceived or influence others down the line. If you have data, put it out there. I firmly believe that having more data, not less, in journals to pubmed through is important. I have heard the view point that only papers of monumental importance and positive results should be allowed to go into print. I look at the articles that have been most important as references to me, and none of them earned the author a nobel prize. Publish your work.

l&usibari · May 30, 2007

I would stress the importance of a solid literature review, in conjunction with writing that difficult introduction. I found that to be the most time-consuming part of the process (other than gathering the data). Also, it can be tough to decide what to say in the discussion, as that's where you get to be creative and make conclusions from your data.

To those people who might say "but no attending has approached me about doing a project!", which I have heard multiple times: you don't need an attending to come up with a project. I think of projects all the time, even sitting in a conference and hearing someone say "I wonder if anyone has studied that?"....well go look in pubmed and see! Once you come up with an idea, find an attending in that particular area, and I guarantee that attending will approach you with more projects (if you do a good job with the first one).

Thaitanium · May 31, 2007

Mindy said:
Publishing is not that hard. I published 7 during residency, and 2 during med school. I have 2 manuscripts just waiting for boards to be over with to complete. Some were little ditties, others more substantial. Here's my (non-PhD) approach:

1) Find an attending who already has an idea, i.e. "Hey look, I've collected 100 cases of X and always wanted to stain them for Y."

2) Develop a hypothesis. Whatever question you are asking needs to have a yes or no answer essentially, i.e. "Does lesion X stain more diffusely for impox Y than its normal counterpart?" DO NOT pick an ambiguous hypothesis. DO NOT choose a project without a well defined end point. This is very important so that you do not drag on forever with your work.

3) Pick your methods, your (statistical) analytic and grading schema, and your conclusions based on your findings. For instance, if the lesion is more positive for Y than normal, then [insert conclusion A here], or, if the lesion has the same positivity as normal, then [insert conclusion B here].

3) Pick a target journal. Get a copy of the author guidelines and follow them to a tee. Write your manuscript exactly for that journal. Look at work that is similar in concept to yours to see how other authors tackled it.

3) Write the intro / methods as the work (e.g. impox) is being done. The intro in my opinion takes the most work.

4) Analyze your data. Use a statistician (which are often available at large universities) if you are uncomfortable with number crunching.

5) Plot your figures/graphs/charts from the data.

6) Summarize your results from the figures of your data for the manuscript. I think that the entire results section works best if done AFTER you do your figures/tables.

7) Write the discussion /conclusion. Be very careful not to make claims that are not actually supported by your data. Draw specific conclusions--as editors have repeatedly told me, drawing no definite conclusions from your work is bad.

8) Have all of your authors look at your (near-complete) first draft, make changes per their input.

9) Send your manuscript out either online or snail mail per the author's instructions. Wait several months for the revision (I did have 1 paper accepted "as is"), revise right away, and send it out again.

10) Rejected? Who cares, send it to the next bad boy (i.e. journal) in line. Remember, though, similar journals may use the same reviewer who rejected you the first time around. I have NEVER had a paper ultimately be rejected. I have had to journal shop to find a good home though 😉

Other bits of publishing advice: CP labs generate HUGE amounts of data, all for the publishing. Just ask around--someone's bound to have a half-finished project looking for a dedicated first author. Keep in mind, case reports are almost as much work as primary (clinical-oriented, don't want to peeve the PhDs!) research. I have published only one, I think, though I have published small case series. I think in rare entities, case reports can be very important. One paper I wrote specifically dealt with how to manage refractory TTP via a case description. TTP is a fairly rare and very often anectdotally treated condition. In fact, we "cured" this patient by using case report data for a fairly experimental approach as a guide, so felt it was important to add ours to the literature.

Finally, in regard to fellowships and research: I think that the resident who publishes (and is a good pathologist) will be considered a superior candidate to the resident who does not publish. Why? Salaries in academics are based on publication quantity. A fellow who pumps out papers for their attendings is a huge financial plus. A person with a track record for being able to publish and do their work during residency is ideal.

Mindy

Thanks Mindy and lusibari...

I have one publication from grad school and I still would like to improve on my writing. Is there a site/book you can refer me to in regards to this? For example, how to write a good introduction, results, conclusion sections of a publication, what to NOT write/what to write (like you stated in #7 above)...I think I need a "Writing for Medical Journals for DUMMIES book".

Thanks in advance.

DropkickMurphy · May 31, 2007

Oh yeah, one more point, there is a paper to be made out of every collection of data. You just need to be creative enough to see the point of it all...

And if anyone needs someone to help, you know where to find me. 😉 I'm cheap labor. :laugh:

BU Pathology · May 31, 2007

Mindy said:
Publishing is not that hard. I published 7 during residency, and 2 during med school. I have 2 manuscripts just waiting for boards to be over with to complete. Some were little ditties, others more substantial. Here's my (non-PhD) approach:

1) Find an attending who already has an idea, i.e. "Hey look, I've collected 100 cases of X and always wanted to stain them for Y."

2) Develop a hypothesis. Whatever question you are asking needs to have a yes or no answer essentially, i.e. "Does lesion X stain more diffusely for impox Y than its normal counterpart?" DO NOT pick an ambiguous hypothesis. DO NOT choose a project without a well defined end point. This is very important so that you do not drag on forever with your work.

3) Pick your methods, your (statistical) analytic and grading schema, and your conclusions based on your findings. For instance, if the lesion is more positive for Y than normal, then [insert conclusion A here], or, if the lesion has the same positivity as normal, then [insert conclusion B here].

3) Pick a target journal. Get a copy of the author guidelines and follow them to a tee. Write your manuscript exactly for that journal. Look at work that is similar in concept to yours to see how other authors tackled it.

3) Write the intro / methods as the work (e.g. impox) is being done. The intro in my opinion takes the most work.

4) Analyze your data. Use a statistician (which are often available at large universities) if you are uncomfortable with number crunching.

5) Plot your figures/graphs/charts from the data.

6) Summarize your results from the figures of your data for the manuscript. I think that the entire results section works best if done AFTER you do your figures/tables.

7) Write the discussion /conclusion. Be very careful not to make claims that are not actually supported by your data. Draw specific conclusions--as editors have repeatedly told me, drawing no definite conclusions from your work is bad.

8) Have all of your authors look at your (near-complete) first draft, make changes per their input.

9) Send your manuscript out either online or snail mail per the author's instructions. Wait several months for the revision (I did have 1 paper accepted "as is"), revise right away, and send it out again.

10) Rejected? Who cares, send it to the next bad boy (i.e. journal) in line. Remember, though, similar journals may use the same reviewer who rejected you the first time around. I have NEVER had a paper ultimately be rejected. I have had to journal shop to find a good home though 😉

Other bits of publishing advice: CP labs generate HUGE amounts of data, all for the publishing. Just ask around--someone's bound to have a half-finished project looking for a dedicated first author. Keep in mind, case reports are almost as much work as primary (clinical-oriented, don't want to peeve the PhDs!) research. I have published only one, I think, though I have published small case series. I think in rare entities, case reports can be very important. One paper I wrote specifically dealt with how to manage refractory TTP via a case description. TTP is a fairly rare and very often anectdotally treated condition. In fact, we "cured" this patient by using case report data for a fairly experimental approach as a guide, so felt it was important to add ours to the literature.

Finally, in regard to fellowships and research: I think that the resident who publishes (and is a good pathologist) will be considered a superior candidate to the resident who does not publish. Why? Salaries in academics are based on publication quantity. A fellow who pumps out papers for their attendings is a huge financial plus. A person with a track record for being able to publish and do their work during residency is ideal.

Mindy

Absolutely outstanding post!

It is more than possible to publish during your residency, and it will substantially improve your chances of fellowship and/or future employment. If two candidates with nearly equal credentials apply for the same position, regardless of whether it is industry, private practice, government, or academics, the candidate with publications will have a substantial advantage. Publishing demonstrates that you are willing to do additional work to enhance the discipline of pathology, a highly desirable characteristic. Published papers are easily quantified and quoted "This resident published 2 papers on amyloid, including an interesting one that described . . . ".

Your publications become part of your curriculum vitae that will remain with you for the rest of your career. Publications that are done well add substantially to our knowledge and serve to improve the health of all peoples.

Dan Remick
Chair, Department of Pathology and Laboratory Medicine
Boston University

yaah · May 31, 2007

You basically have to squeeze it in, and the importance of initiative cannot be understated. I have been approached by attendings about projects, but this is only after I started others on my own initiative. By end of second year I had one publication submitted and four others nearing completion of data collection. One of those has stalled because it is outside my interest areas, and another because it didn't really resolve anything. The other two are currently submitted, plus there is a sixth project that I peripherally participated in and manuscript about to be submitted. There are a couple of others in the works too. It is a LOT of work at times, generally the work comes in spurts as attendings get free time and want stuff done or get finished with things you gave to them awhile back. I pride myself on being a fairly efficient person but sometimes it gets hectic. One of our papers was rejected on first submission, then accepted later, and this becomes a hassle also. I suspect I will have at least four first author pubs by the time I start my fellowship, and will have others in the works. It is very rewarding to follow something through to completion from the start. I think many residents are often looking for quick and easy projects or things that they can just get their name on, but that's the wrong approach. If you work hard on a project, even if it doesn't get you a first author publication, it can still be important.

It is all definitely doable, but unfortunately it does often require finding the right attending(s) and the right project!

But also unfortunately, since fellowship apps are now earlier due to elimination of the fifth year, you do have to be "on your way" by the end of second year in many cases. That doesn't necessarily mean you have to be published though. Having ongoing projects or USCAP abstracts or whatever is almost (almost) as good.

Some people also ask whether abstracts and posters are just as good - they are not for academic purposes, but they are helpful. They show interest and are important, but publications are the key "stat" for landing academic jobs, in general. If you finish residency with a few first author publications you are in very good shape, so I hear (although in part it also depends on your area of interest).

l&usibari · May 31, 2007

yaah said:
One of those has stalled because it is outside my interest areas, and another because it didn't really resolve anything.

I have similar issues with projects I agreed to do early on in residency that have stalled out because they are completely not in my area of interest, or they are with attendings who do not have good track records of publishing (so not "high-yield" for me), or they are projects where there is no guarantee I will even get a publication out of it. Unfortunately I agreed to do them so will have to tackle them eventually, but only after hammering out the more important projects. And by important I mean 1) in my field of interest, 2) with attendings who churn out publications, 3) I am writing as first author so have near-complete control over them, or 4) about a subject that is currently a hot topic in the literature.

Mindy · May 31, 2007

Thaitanium said:
Thanks Mindy and lusibari...

I have one publication from grad school and I still would like to improve on my writing. Is there a site/book you can refer me to in regards to this? For example, how to write a good introduction, results, conclusion sections of a publication, what to NOT write/what to write (like you stated in #7 above)...I think I need a "Writing for Medical Journals for DUMMIES book".

Thanks in advance.

Hi Thait: The best way to learn to write a journal article is to read journal articles. Think of your idea, and as Lusibari made note of, read all and everything central to your idea (while concurrently writing your introduction.) You do not need a special book for this, there are more articles than dirt available to look through. Early on, just emulate journal styles you like. As far as what not to write, just stick with the facts. Reference EVERYTHING! Don't even think of plagarizing. If your work is good & accurate, you cannot go wrong.

Lusibari also pointed out something that I have a hard time with as well, and I think it is related to confidence in one's field because its getting easier for me with time--the Discussion. If you have a decent attending supporting your work, they will help you decide what claims you should make, and what you should stay away from in the discussion. You will be safe---but not particularly exciting-- if you make very neutral claims from your work. I have had reviewers essentially say "well written, but boring", because I did not make flashy conclusions. I have also heard "your results are intuitive" and I always think "the world is flat."

Mindy

P.S. Dr. Remick: Let me know if you have project ideas when I'm at the Boston OCME starting July. I am the next fellow there, despite the recent events... (To the rest of SDN: see how easy it is?! 😉 )

BU Pathology · May 31, 2007

Mindy said:
Hi Thait: The best way to learn to write a journal article is to read journal articles. Think of your idea, and as Lusibari made note of, read all and everything central to your idea (while concurrently writing your introduction.) You do not need a special book for this, there are more articles than dirt available to look through. Early on, just emulate journal styles you like. As far as what not to write, just stick with the facts. Reference EVERYTHING! Don't even think of plagarizing. If your work is good & accurate, you cannot go wrong.

Lusibari also pointed out something that I have a hard time with as well, and I think it is related to confidence in one's field because its getting easier for me with time--the Discussion. If you have a decent attending supporting your work, they will help you decide what claims you should make, and what you should stay away from in the discussion. You will be safe---but not particularly exciting-- if you make very neutral claims from your work. I have had reviewers essentially say "well written, but boring", because I did not make flashy conclusions. I have also heard "your results are intuitive" and I always think "the world is flat."

Mindy

P.S. Dr. Remick: Let me know if you have project ideas when I'm at the Boston OCME starting July. I am the next fellow there, despite the recent events... (To the rest of SDN: see how easy it is?! 😉 )

For the discussion, I tell my post-doctoral fellows to find 3 areas to discuss. Work with your mentor to identify these three areas and then focus on those. If you try to read and discuss everything on adenocarcinoma the task is so Herculean that you will be well read but unpublished.

Mindy, I do have an outstanding project that I would like to work on with the Medical Examiner's Office dealing with multiplex cytokine assays and SIDS. Contact me at your convenience and we can discuss in further detail.

Dan Remick, Chair Dept of Path Boston University

LADoc00 · May 31, 2007

I published some stuff during residency, spent ALOT of time on a few papers I solo authored and honestly I dont know if it is worth the effort for most. Honestly, I dont even read all the crap noted researchers write, let alone a resident's paper. I spent sometime at CalTech recently (always keeping an eye out for new tech ideas) and one of their theoretical physics big wigs said that research is carried on the wings of that 1% truly doing something productive and I would bet the farm no one here is. I can see papers if you are dead set on academics, but then again if I personally was doing academic research I wouldnt even be spending time signing glass out....anyway, enough of my ramblings..yeah, *maybe* papers will get you a dermpath fellowship somewhere, then again so will being drinking buddies with the right people.

I dont know, there is so much crap published all the gems end up buried in mounds of poo.

I guess my point is dont write papers thinking it will get you some feather on the CV and a cush job. Time would be better spent making real world connections.

zigmund · May 31, 2007

sounds like everyone is focused on publishing for the sake of publishing and polluting the pool of literature with garbage....

sequela · May 31, 2007

i agree w both ladoc and zigmund...there is a LOT of crap publications out there. a lot. and it is very likely that there is only a small handful of folks at every institutaion that can truly bring home the gold (i mean that personally and professionally) in terms of their research.

i think it's important to explore this particular skill set and learn how to ask a relevant question, develop and see projects to the end and most importantly, add valuable and thoughtful ideas/findings to the literature. but if you're doing it to fluff a cv w a bunch of crap then yeah, you certainly are better off making it to happy hour. or even conferences.

DropkickMurphy · May 31, 2007

LADoc00 said:
I published some stuff during residency, spent ALOT of time on a few papers I solo authored and honestly I dont know if it is worth the effort for most. Honestly, I dont even read all the crap noted researchers write, let alone a resident's paper. I spent sometime at CalTech recently (always keeping an eye out for new tech ideas) and one of their theoretical physics big wigs said that research is carried on the wings of that 1% truly doing something productive and I would bet the farm no one here is. I can see papers if you are dead set on academics, but then again if I personally was doing academic research I wouldnt even be spending time signing glass out....anyway, enough of my ramblings..yeah, *maybe* papers will get you a dermpath fellowship somewhere, then again so will being drinking buddies with the right people.

I dont know, there is so much crap published all the gems end up buried in mounds of poo.

I guess my point is dont write papers thinking it will get you some feather on the CV and a cush job. Time would be better spent making real world connections.

Just out of curiosity (and not that I am not agreeing with you at least in principle) what do you classify as that productive 1%?

djmd · May 31, 2007

zigmund said:
sounds like everyone is focused on publishing for the sake of publishing and polluting the pool of literature with garbage....

Not me. I did my research and wrote my abstract....

And then I took the abstract, the data and put them in a burlap sack, and tossed the sack into Pennsylvania coal mine.

The Slides were broken and melted down and turned back into sand. The TMA's were broken into four pieces and each piece was given to the fast rider and told to ride to the four corners of the earth...

and the hobbits assure me that the blocks have been tossed into Mt. Doom.

Mindy · May 31, 2007

The way I see it is that pathology residents can make a choice:

1) They can follow their guts toward a certain "lifestyle", in essence, go into private practice because they think that is where the most money can be made for the least amount of work. We all hear this viewpoint ad nauseum on SDN

-or-

2) They can be leaders in the field of pathology.

Some critics are very loud voices on this forum, but in the field of pathology they are absolutely powerless. I am sure that the audience here recognizes that. I think the disgruntled sarcasm just hides the fact that some of the older members out there wish they had made a bigger impact in their field when they had a chance. Maybe the money wasn't all that important after all? Too bad the initial call of greed was so appealling...

Like I said, publishing is easy, but you need to have initiative. And you cannot be a leader in pathology if you do not publish. And no amount of drinks at a bar with future bosses will give you credentials to be a leader. Real world connections? What exactly does that mean? Like getting to know your formalin vendor's dog by name so you can ask how "fluffy" is when he comes by? To me, real world connections is a network of professionals--academics--who share intellectual ideas on the national and international front, contributing to both the knowledge and policies of medicine. That is the "real world" connections I am interested in continually acquiring.

Padding a CV with research papers? Well, that is an earned bonus to good completed work. An abstract that does not make it to press is an unfinished job, in my opinion. I do not have to rely on "treasurer of the welcoming club" to fill up lines in my resume. Since I am hardly anonymous, why don't you read my papers? I think you'll find that they all contribute to the literature. In fact, some of them have had a very serious documentable impact already (PM me if you want to know what I am referring to). The argument of "lots of crap in publication" and "diluting the good stuff" is ALWAYS made by people with no pubs on their CV.

I wouldn't waste my time responding at such length, but I know there are a lot of young, inexperienced readers of this forum. Ones who need much better role models than I sometimes see here. I don't want their viewpoint discolored by a cynical, grumpy, ill-mannered soliloquist. In fact, I sometimes wonder why everything I write, or why everything that has to do with forensics/autopsies is met with such a venomous response by one particular SDN'er... Did I do something mean to you or hurt your feelings in the "real world" that I am unaware of, LA? Isn't that now called "cyber-bullying"? :laugh:

Mindy

LADoc00 · May 31, 2007

As Ive said numerous times, pathologists can be divided into those that are realists and move through life with a pragmatic understanding of the true value of tasks OR they can permenantly rap themselves in the cocoon of idealism and march forward in ignorance hoping never to stumble out of the thick haze of academia.

There are pros and cons of each. But I strive to present a balanced perspective. That perspective includes:
~99% of published research is drivel, beyond drivel, that 99% crap is holding back the real 1% will push society forward
~A vast majority of people who publish have motives unrelated to the purity of the human understanding of disease, they are shameless self-promoters, smoke-n-mirrors con men, fearmongerers or even worse simply out and out frauds.
~The scientific publishing industry is a multi-million business built around....guess what? Profit! They will publish 10 million articles of pseudoscience junk if it sells advertising.
~Scientists can be bought and for cheap to sit on review boards. Hell, it barely takes a few thousand bucks to buy an NIH scientist, nothing in the world of advertising.

Mindy I really dont care what you do with your life and frankly I wish you luck. Please dont take my perspective as a personal attack, it is not.

Modern medicine is rapidly changing, I ask everyone to consider it is no longer the "Golden Age" like it was in the 1970-1980s. Universities have whored themselves out en masse to big Biopharma. We have left the Garden of Eden and folks, there is no going back.....

DropkickMurphy · May 31, 2007

LADoc00 said:
As Ive said numerous times, pathologists can be divided into those that are realists and move through life with a pragmatic understanding of the true value of tasks OR they can permenantly rap themselves in the cocoon of idealism and march forward in ignorance hoping never to stumble out of the thick haze of academia.

There are pros and cons of each. But I strive to present a balanced perspective. That perspective includes:
~99% of published research is drivel, beyond drivel, that 99% crap is holding back the real 1% will push society forward
~A vast majority of people who publish have motives unrelated to the purity of the human understanding of disease, they are shameless self-promoters, smoke-n-mirrors con men, fearmongerers or even worse simply out and out frauds.
~The scientific publishing industry is a multi-million business built around....guess what? Profit! They will publish 10 million articles of pseudoscience junk if it sells advertising.
~Scientists can be bought and for cheap to sit on review boards. Hell, it barely takes a few thousand bucks to buy an NIH scientist, nothing in the world of advertising.

Mindy I really dont care what you do with your life and frankly I wish you luck. Please dont take my perspective as a personal attack, it is not.

Modern medicine is rapidly changing, I ask everyone to consider it is no longer the "Golden Age" like it was in the 1970-1980s. Universities have whored themselves out en masse to big Biopharma. We have left the Garden of Eden and folks, there is no going back.....

Another excellent post from everyone's favorite disgruntled pathologist......

sequela · May 31, 2007

Mindy said:
The way I see it is that pathology residents can make a choice:

1) They can follow their guts toward a certain "lifestyle", in essence, go into private practice because they think that is where the most money can be made for the least amount of work. We all hear this viewpoint ad nauseum on SDN

-or-

2) They can be leaders in the field of pathology.

Some critics are very loud voices on this forum, but in the field of pathology they are absolutely powerless. I am sure that the audience here recognizes that. I think the disgruntled sarcasm just hides the fact that some of the older members out there wish they had made a bigger impact in their field when they had a chance. Maybe the money wasn't all that important after all? Too bad the initial call of greed was so appealling...

Like I said, publishing is easy, but you need to have initiative. And you cannot be a leader in pathology if you do not publish. And no amount of drinks at a bar with future bosses will give you credentials to be a leader. Real world connections? What exactly does that mean? Like getting to know your formalin vendor's dog by name so you can ask how "fluffy" is when he comes by? To me, real world connections is a network of professionals--academics--who share intellectual ideas on the national and international front, contributing to both the knowledge and policies of medicine. That is the "real world" connections I am interested in continually acquiring.

Padding a CV with research papers? Well, that is an earned bonus to good completed work. An abstract that does not make it to press is an unfinished job, in my opinion. I do not have to rely on "treasurer of the welcoming club" to fill up lines in my resume. Since I am hardly anonymous, why don't you read my papers? I think you'll find that they all contribute to the literature. In fact, some of them have had a very serious documentable impact already (PM me if you want to know what I am referring to). The argument of "lots of crap in publication" and "diluting the good stuff" is ALWAYS made by people with no pubs on their CV.

I wouldn't waste my time responding at such length, but I know there are a lot of young, inexperienced readers of this forum. Ones who need much better role models than I sometimes see here. I don't want their viewpoint discolored by a cynical, grumpy, ill-mannered soliloquist. In fact, I sometimes wonder why everything I write, or why everything that has to do with forensics/autopsies is met with such a venomous response by one particular SDN'er... Did I do something mean to you or hurt your feelings in the "real world" that I am unaware of, LA? Isn't that now called "cyber-bullying"?

Mindy

mindy...nobody is attacking you. i certainly admire your position and believe you to be sincere in your pursuits and dedication to academia.

i was only responding to the original post as it relates to research for cv padding for the intented purpose of landing a fellowship.

while this may not be your reason for doing projects, you can not deny that it happens. it happens at all levels of medical education. there are several threads about doing "research" to improve one's cv. it's on every freakin' specialty forum.

my comment about the happy hour pertains to landing a fellowship/job opportunities, not a position of "leadership" in pathology. no intelligent person would suggest that you could one day be an editor of robbins or whatever if you party with all the right people. that's idiotic. but in the working world, where jobs and such opportunities are concerned, yes, it absolutely matters if you have strong contacts and great interpersonal skills. while it may not make you a chair of a pathology department, it may get you the position you seek. i am sure this is the case in private practice and to tell you the truth, i am sure it doesn't hurt in academics either.

furthermore, your description of real world connections, as they pertain to academics, is very inspiring and i really hope it to be true. but in all honesty, i have a hard time believing that academics is not rot with its own brand of bull**** and politics so thick that it makes you want scream.

finally, while your work may be valuable, there is also no denying that there is plenty of crap out there. are you really suggesting that the literature is not plagued by a lot of crap? i find that hard to believe. publish or perish??? i mean come on, that kinda philosophy breeds CRAP. that is the culture that currently exists and i'm sorry but that's a modified form of capitalism (productivity based), not science.

simply put, there is a vast difference between the "leadership" track you describe, and what it takes to be competitive for fellowships. while in theory they should be the same thing, it often turns out that they are not. that is the real world. i think of dermpathlover as an example. pls refer to his posts for a better understanding of what i mean.

yaah · May 31, 2007

You know, there is more to research than just CV padding or positioning yourself for better positions. Everyone has to start somewhere. I have no idea whether 99% of research is crap, I would bet no and that is a gross oversimplification for people who want to do other things with their careers (which is fine). But I don't really understand the purpose of impugning people who want to do projects as either conmen or suckups (and either way delusional). Publications are hard work, and oftentimes they are unrewarding - but that's part of the process. Not everything is a success, just like not everything is a failure.

One doesn't only publish research that is ground breaking. Progress is made incrementally. Obviously there are unnecessary papers published - sometimes things just seem to be reiterations of something already published. Comments like "A vast majority of people who publish have motives unrelated to the purity of the human understanding of disease, they are shameless self-promoters, smoke-n-mirrors con men, fearmongerers or even worse simply out and out frauds," are inaccurate and misleading. Obviously, not everyone writing journal articles thinks they are going to change the world, but don't confuse a few malintentioned bigwigs for everyone out there.

And research is important for CVs - and not just because of "numbers." As said above, research shows you can follow projects, take initiative, understand things in detail, etc. It may not directly relate to your entire job performance, but it if often a good indication. A hard working resident who participates in projects is often going to be a good pathologist also. The kind of people fellowship directors are looking for.

Mindy · May 31, 2007

LADoc00 said:
As Ive said numerous times, pathologists can be divided into those that are realists and move through life with a pragmatic understanding of the true value of tasks OR they can permenantly rap themselves in the cocoon of idealism and march forward in ignorance hoping never to stumble out of the thick haze of academia.

There are pros and cons of each. But I strive to present a balanced perspective. That perspective includes:
~99% of published research is drivel, beyond drivel, that 99% crap is holding back the real 1% will push society forward
~A vast majority of people who publish have motives unrelated to the purity of the human understanding of disease, they are shameless self-promoters, smoke-n-mirrors con men, fearmongerers or even worse simply out and out frauds.
~The scientific publishing industry is a multi-million business built around....guess what? Profit! They will publish 10 million articles of pseudoscience junk if it sells advertising.
~Scientists can be bought and for cheap to sit on review boards. Hell, it barely takes a few thousand bucks to buy an NIH scientist, nothing in the world of advertising.

Mindy I really dont care what you do with your life and frankly I wish you luck. Please dont take my perspective as a personal attack, it is not.

Modern medicine is rapidly changing, I ask everyone to consider it is no longer the "Golden Age" like it was in the 1970-1980s. Universities have whored themselves out en masse to big Biopharma. We have left the Garden of Eden and folks, there is no going back.....
Scientists can be bought and for cheap to sit on review boards. Hell, it barely takes a few thousand bucks to buy an NIH scientist, nothing in the world of advertising.

Here are some of my perspectives then:

1) Funny, last article I reviewed, nobody bought me anything. And yes, I have very officially been a journal reviewer. And you know what? I was honored to do so.

2) You insult all of your teachers. They certainly deserve a lot more respect than you give them. Unless of course you are the self-made man.

3) I'll bet major league ball players, actors, and heck, even Bill Gates were all once "rap[ped]...in a cocoon of idealism" and entirely unrealistic as well. Of course, as a pathologist, I am certainly different that they are with my quixotic notions, right? Believing so ludicrously that I can have an impact on the field of forensic and autopsy pathology, right? Sure, far-fetched...

4) I know you do not care what I do with my life. You care what all of these undecided SDN'ers do with their lives. You do not want them to go down the "ugly" route of academia. You do not want them to believe that they to can contribute to pathology or whatever fields they choose. You want them to give up, go for the bucks, like you did! Whose WHO classifications do you turn to? Ever read the names? These are not unreachable superstars, these are our attendings! We are the next generation. Or we can be if we choose to. Head-in-the-clouds optimist? Heck, I see these possibilities right around the corner. To me, there is nothing at all surreal or dreamy about what my future potential is. Or anyone else on this site who chooses to grab for the golden ring.

5) I disagree with the notion that most research is crap. I personally think that no one paper prevails in guiding a certain medical position. I look at the entirety of the body of knowledge on a given subject, and figure that by aiming in the middle, I'll have some idea of what the "truth" of the subject is. This is one of the reasons I think it is extremely important to publish data and in particular "negative" results.

6) Politics, connections, etc. are very important. Putting down people who both hold the key to your future fellowships and who have worked a lifetime at their given niche is not a great way to build strong relationships. What people put time and effort into is what they care deeply about. Most people in academics have chosen to be in academics, making a lot of sacrifices for what they believe in. They can smell a rat a mile away. Sometimes the rat who fakes an interest is better than the rat who shows no interest at all...

Mindy

miko2005 · Jun 1, 2007

Mindy said:
Publishing is not that hard. I published 7 during residency, and 2 during med school. I have 2 manuscripts just waiting for boards to be over with to complete. Some were little ditties, others more substantial. Here's my (non-PhD) approach:

1) Find an attending who already has an idea, i.e. "Hey look, I've collected 100 cases of X and always wanted to stain them for Y."

2) Develop a hypothesis. Whatever question you are asking needs to have a yes or no answer essentially, i.e. "Does lesion X stain more diffusely for impox Y than its normal counterpart?" DO NOT pick an ambiguous hypothesis. DO NOT choose a project without a well defined end point. This is very important so that you do not drag on forever with your work.

3) Pick your methods, your (statistical) analytic and grading schema, and your conclusions based on your findings. For instance, if the lesion is more positive for Y than normal, then [insert conclusion A here], or, if the lesion has the same positivity as normal, then [insert conclusion B here].

3) Pick a target journal. Get a copy of the author guidelines and follow them to a tee. Write your manuscript exactly for that journal. Look at work that is similar in concept to yours to see how other authors tackled it.

3) Write the intro / methods as the work (e.g. impox) is being done. The intro in my opinion takes the most work.

4) Analyze your data. Use a statistician (which are often available at large universities) if you are uncomfortable with number crunching.

5) Plot your figures/graphs/charts from the data.

6) Summarize your results from the figures of your data for the manuscript. I think that the entire results section works best if done AFTER you do your figures/tables.

7) Write the discussion /conclusion. Be very careful not to make claims that are not actually supported by your data. Draw specific conclusions--as editors have repeatedly told me, drawing no definite conclusions from your work is bad.

8) Have all of your authors look at your (near-complete) first draft, make changes per their input.

9) Send your manuscript out either online or snail mail per the author's instructions. Wait several months for the revision (I did have 1 paper accepted "as is"), revise right away, and send it out again.

10) Rejected? Who cares, send it to the next bad boy (i.e. journal) in line. Remember, though, similar journals may use the same reviewer who rejected you the first time around. I have NEVER had a paper ultimately be rejected. I have had to journal shop to find a good home though 😉

Other bits of publishing advice: CP labs generate HUGE amounts of data, all for the publishing. Just ask around--someone's bound to have a half-finished project looking for a dedicated first author. Keep in mind, case reports are almost as much work as primary (clinical-oriented, don't want to peeve the PhDs!) research. I have published only one, I think, though I have published small case series. I think in rare entities, case reports can be very important. One paper I wrote specifically dealt with how to manage refractory TTP via a case description. TTP is a fairly rare and very often anectdotally treated condition. In fact, we "cured" this patient by using case report data for a fairly experimental approach as a guide, so felt it was important to add ours to the literature.

Finally, in regard to fellowships and research: I think that the resident who publishes (and is a good pathologist) will be considered a superior candidate to the resident who does not publish. Why? Salaries in academics are based on publication quantity. A fellow who pumps out papers for their attendings is a huge financial plus. A person with a track record for being able to publish and do their work during residency is ideal.

Mindy

Mindy,

I think this is a great post that clearly took a lot of effort and thought. Thanks for posting it.

deschutes · Jun 1, 2007

Mindy said:
Publishing is not that hard. Here's my (non-PhD) approach:
< snip >

Mindy,

Thank you much for that post, and for the statement that "publication is communication". I couldn't agree more.

There is a great deal that can be learnt about the nature of information from seeing a project through completion.

I'm not going to get into the "why bother to publish" discussion for now, because of time constraints, apart from to say that it is not a question of "connections" on one hand and "publications" on the other. Success often comes from a combination of both, and one often leads to another.

I believe that the so-called "tricks of the trade" (or skills, if you like) of publishing can be learnt, and that is why I made my original post apart from the spirit of the rant. I limited the scope of the post to fellowship applications (it always gets expanded anyway), since I felt that basic science research discussions that had taken place in the past were no help to say, someone whose first degree was their M.D.

LADoc00 · Jun 1, 2007

yaah said:
You know, there is more to research than just CV padding or positioning yourself for better positions. Everyone has to start somewhere. I have no idea whether 99% of research is crap, I would bet no and that is a gross oversimplification for people who want to do other things with their careers (which is fine). But I don't really understand the purpose of impugning people who want to do projects as either conmen or suckups (and either way delusional). Publications are hard work, and oftentimes they are unrewarding - but that's part of the process. Not everything is a success, just like not everything is a failure.

One doesn't only publish research that is ground breaking. Progress is made incrementally. Obviously there are unnecessary papers published - sometimes things just seem to be reiterations of something already published. Comments like "A vast majority of people who publish have motives unrelated to the purity of the human understanding of disease, they are shameless self-promoters, smoke-n-mirrors con men, fearmongerers or even worse simply out and out frauds," are inaccurate and misleading. Obviously, not everyone writing journal articles thinks they are going to change the world, but don't confuse a few malintentioned bigwigs for everyone out there.

And research is important for CVs - and not just because of "numbers." As said above, research shows you can follow projects, take initiative, understand things in detail, etc. It may not directly relate to your entire job performance, but it if often a good indication. A hard working resident who participates in projects is often going to be a good pathologist also. The kind of people fellowship directors are looking for.

The point of my hyperbole posts was to demonstrate how ingrained it is that research efforts be quantified into CV lines as publications. You need to rack up a bunch of crap publications and presentations to acomplish your goals and I have seen FAR too many residents and fellows mistakenly bellieve that padding CVs is somehow superior to having a better understanding of health care delivery as the real business it is.

Research is a hobby for most IMO. They follow down lines that interest them, explore out of personal curiosity and then move it. That is awesome. But what I really feel strongly about is the :

the objective of undertaking research projects during residency is to get yourself a fellowship.

Click to expand...

attitude.

Time is an invaluable commodity so be aware how you spend it.

yaah · Jun 2, 2007

I agree with that, that some residents may think the way to fellowship or professional glory is to spend their time on projects as opposed to actually learning about the field. That's a shame when that happens, ultimately you are only hurting yourself. But at the same time I think that many of the residents who do many projects during residency are also the same ones who study the most and have the most general knowledge about the field. It isn't really an "either/or" proposition.

Thaitanium · Jun 2, 2007

Is there a difference between first-authored publications vs. non-first authored papers when it comes to obtaining fellowships? Do PDs favor those who have the former, which takes a lot more work than let's say the latter, which you can get by just doing less work and "piggybackin'" onto the publication?

Thanks.

CameronFrye · Jun 2, 2007

Thaitanium said:
Is there a difference between first-authored publications vs. non-first authored papers when it comes to obtaining fellowships? Do PDs favor those who have the former, which takes a lot more work than let's say the latter, which you can get by just doing less work and "piggybackin'" onto the publication?

Thanks.

Of course there is.

106174 · Jun 2, 2007

Thaitanium said:
Is there a difference between first-authored publications vs. non-first authored papers when it comes to obtaining fellowships? Do PDs favor those who have the former, which takes a lot more work than let's say the latter, which you can get by just doing less work and "piggybackin'" onto the publication?

Thanks.

and everybody knows how much work the first author really does to get a paper published (compared to all the other authors).

1Path · Jun 2, 2007

deschutes said:
Success often comes from a combination of both, and one often leads to another

Great point!

And Dr.Mindy, what can I say? You ARE the bomb and I hope to meet you at NAME this year.

I would however to add a little something about your suggestions about publishing. Just before you submit your paper, do a quick pubmed search to make sure you haven't been "scooped" in the process. Also a good idea to do before presenting data from a current/future publication as well!

Mindy · Jun 3, 2007

1Path: See ya in Savannah! There is supposed to be a special resident/fellow event scheduled in this year, hopefully there is!

Mindy

docbiohazard · Jun 3, 2007

So, this is a question I probably need to post over in the MD/PhD forums, but as it is specific to Pathology and this thread has meandered in that direction, I thought I'd go ahead and post it here (if it's too much of a threadjack, I apologize in advance)...

As an MD/PhD interested in a career in academic pathology, I'm looking at programs trying to decide how "research oriented" a residency or tract I want to pursue. The classic dichotomy I've read about on here would be MGH v. BWH, at least in terms of reputation in the past, that MGH breeds top notch diagnosticians where BWH is more oriented towards breeding top notch research oriented pathologists.

My question is, as I've already devoted 4 years of my life to research training and my PhD, should I be focusing on finding the best clinical/diagnostic education experience I can find, or should I go on a more research oriented tract to allow me to "keep up my skills" in the research world, publishing, and the like? I've asked some faculty I know and I've gotten a slew of answers kind of across the board, just curious about the residence experience.

The third option would be a residency with a "research track" (like the SPLIT program at MGH), however there again, I can't decide if that's really designed more to train someone with an MD who decides they're interested in research, and would be somewhat redundant for an MD/PhD. My turnoff with that program (and others) is that they seem to require you to pick either AP or CP to board in, and I'd prefer to go AP/CP (although I notice in some cases there appear to be AP/CP residents in those programs)...

Just curious for the thoughts of any MD/PhD residents, or research/academic oriented path residents, and what they might think.

Best regards,
BH

Mrbojangles · Jun 3, 2007

Here's kind of a silly question. I'm working on a paper right now and was wondering if the number of references you have has any influence on whether your paper is accepted or if it is a requirement for some journals.

b&ierstiefel · Jun 3, 2007

docbiohazard said:
So, this is a question I probably need to post over in the MD/PhD forums, but as it is specific to Pathology and this thread has meandered in that direction, I thought I'd go ahead and post it here (if it's too much of a threadjack, I apologize in advance)...

I think your question is quite appropriate for this given thread...your post is not a "threadjack" by any means.

As an MD/PhD interested in a career in academic pathology, I'm looking at programs trying to decide how "research oriented" a residency or tract I want to pursue. The classic dichotomy I've read about on here would be MGH v. BWH, at least in terms of reputation in the past, that MGH breeds top notch diagnosticians where BWH is more oriented towards breeding top notch research oriented pathologists.

Yes, in the past, BWH was singled out and contrasted from programs such as MGH and Hopkins (the latter two which have the reputation of being diagnostically strong). I'm gonna leave out Hopkins from the rest of the discussion as I am doing my residency in Boston and the last time I did any sort of training in Baltimore was a decade ago.

MGH training diagnosticians and BWH training researchers...that stereotypical dichotomy is quite outdated now. It has been for several years, especially since Ramzi Cotran's death. BWH has become stronger in terms of clinical work. At the same time, MGH has a new chair, David Louis, who is very research oriented and trying to attract more research type folks, from what I hear, to the MGH. The "gap" between the two programs is shrinking. This does make it more difficult for the applicant who wants to train at one of the two institutions to decide which program is right for him/her.

Personally, I can't speak for MGH although I have to say I would be shocked if the quality of the clinical training there was deteriorating. From the rumors I hear, the training is still top notch. But what I can say is this...I really value the clinical training I am receiving at BWH. The volume is really high, things can be busy but I see a lot and I'm learning a lot. This I appreciate more and more since making the personal decision to no longer pursue a career in pure basic science research (i.e., this bierstiefel will not be doing a postdoc).

And our program is a good one...such that I do not see my time here simply as some kind of sacrificial investment where I'm gonna sweat blood and tears just to get the H-stamp on my resume so that I can land a sweet job. Again, we get great diagnostic training. And I'm actually relieved to see the "gap" between MGH and BWH shrink because stereotypes only serve to victimize rather than help individuals.

My question is, as I've already devoted 4 years of my life to research training and my PhD, should I be focusing on finding the best clinical/diagnostic education experience I can find, or should I go on a more research oriented tract to allow me to "keep up my skills" in the research world, publishing, and the like? I've asked some faculty I know and I've gotten a slew of answers kind of across the board, just curious about the residence experience.

You have a PhD. Many don't. You have scientific training. Others don't. You're in a very unique position where you have the expertise (and I believe that grad school OR postdoc--and not necessarily both--is sufficient training) to critically evaluate data and devise thoughtful and relevant projects.

Residency is exactly that...residency. This is the time to learn clinical skills. If you wanted to focus on research, as I once did, you should just drop this clinical bit altogether and go straight to postdoc after medical school...SERIOUSLY! The problem with the MD/PhD track is that it caters to our insecurities and makes us feel some sense of obligation to "wear two hats at once". That doubles the amount of training and one actually feels more lost the longer he/she goes without committing to a particular career track. You have the research skills...you earned the PhD. Enough said. Now if you want to develop diagnostic skills, do a residency and focus on that. I didn't do that during the first year...and now I feel like I'm playing catchup so don't go into residency with the mindset I had.

The third option would be a residency with a "research track" (like the SPLIT program at MGH), however there again, I can't decide if that's really designed more to train someone with an MD who decides they're interested in research, and would be somewhat redundant for an MD/PhD. My turnoff with that program (and others) is that they seem to require you to pick either AP or CP to board in, and I'd prefer to go AP/CP (although I notice in some cases there appear to be AP/CP residents in those programs)...

I never heard of this program at MGH...must be somewhat new especially something that coincides wtih David Louis's arrival as new department chairman. Look, if you're gonna pursue a heavily basic science career with little diagnostic work on the side, you need three things:

1) Focused residency training and then subspecialty training (no AP/CP because as a researcher...you're gonna be doing one, not the other. AP/CP further fuels the insecurities and this perceived need to have "backup plans").
2) A postdoc and grant funding during this time (e.g., K08)
3) Mentorship to maximize the chances of success.

I believe that #3 is the most important of all. If this SPLIT program is going to be of any use for anyone, it will provide #3. The actual training will come from your fellowship and/or postdoc...NOT some makeshift program with a sexy name such as STAR, PSTP, MMTP, SPLIT, blah blah blah. If you're feeling that you're completely on your own to make things happen, chances are high that you will make bad decisions and fail. You need people to give you "heads up" advice and set you up with great opportunities. You've come too far to get f'd over in this very treacherous career track. You deserve better. You deserve "guarantees".

b&ierstiefel · Jun 3, 2007

Mrbojangles said:
Here's kind of a silly question. I'm working on a paper right now and was wondering if the number of references you have has any influence on whether your paper is accepted or if it is a requirement for some journals.

Not a silly question.

And the answer to both questions is "no".

b&ierstiefel · Jun 3, 2007

sequela said:
i agree w both ladoc and zigmund...there is a LOT of crap publications out there. a lot. and it is very likely that there is only a small handful of folks at every institutaion that can truly bring home the gold (i mean that personally and professionally) in terms of their research.

i think it's important to explore this particular skill set and learn how to ask a relevant question, develop and see projects to the end and most importantly, add valuable and thoughtful ideas/findings to the literature. but if you're doing it to fluff a cv w a bunch of crap then yeah, you certainly are better off making it to happy hour. or even conferences.

This is very frustrating. Unfortunately, the culture in academics only serves to propagate this sort of chicanery.

See the thing is, if you go into private practice, you make much more money and you don't have to publish anything.

If you go into academics, however, you make less money. SIGNIFICANTLY LESS MONEY! And without publications, your job and salary are STAGNANT. Hence, if you ever want to improve your financial situation, you have to count on being promoted. How does one get promoted? It has nothing to do with whether you sign out 10000 prostate cores vs. 5000 prostate cores. It has to do with how many papers you publish. Hence, the junior attendings are under constant pressure to publish to get promoted for a modest but significant increase in salary.

Mindy · Jun 3, 2007

Hi:

I want to 2nd all that Bierstiefel has said re: MGH & Brighams. You will be excellently trained at either program, with potential for either clinical or research careers at each. I would disregard the idea that the 2 programs are on either end of the research/clinical spectrum. Those days really seem to have come to an end in my opinion. Time is unifying their philosophies in resident education. I only really fully understand the MD (non-PhD) side of the coin, though. I have never heard of the SPLIT program, either, though I know we do have a research track available *after* residency is completed that several residents (both MD & MD/PhD) are taking advantage of.

Mindy
MGH

b&ierstiefel · Jun 3, 2007

Mindy said:
Hi:

I want to 2nd all that Bierstiefel has said re: MGH & Brighams. You will be excellently trained at either program, with potential for either clinical or research careers at each. I would disregard the idea that the 2 programs are on either end of the research/clinical spectrum. Those days really seem to have come to an end in my opinion. Time is unifying their philosophies in resident education. I only really fully understand the MD (non-PhD) side of the coin, though. I have never heard of the SPLIT program, either, though I know we do have a research track available *after* residency is completed that several residents (both MD & MD/PhD) are taking advantage of.

Mindy
MGH

Well, there you have it...you've heard the same thing from both sides.

Unfortunately, the applicants are hearing the same drivel these days. Geez, when I heard this kind of talk about the BWH/MGH dichotomy when I applied a few years ago, I thought it was real only to realize that it's BS when I got here. And you still hear applicants perpetuating these myths!

Seriously, we gotta set the record straight. This is ridiculous because these past stereotypes will only serve to disappoint residents who come into either programs with certain expectations.

Anyways, how have you been Mindy? I haven't frequented SDN very much recently.

Oh yeah, and what's this I hear about some BWH/MGH mixer sometime this summer? I briefly heard about this from one of the first year's here.

deschutes · Jun 3, 2007

I would actually prefer to keep this thread in the realm of non-PhD research. The numerous basic science research threads have had their day in the sun in the past, and can be found:

Pathology residents interested in basic science research...a dying breed?
Yes! Another Research Question Thread!
Combined AP/CP + research?
question re: research relevancy to pathology
Research experience and path residency

And of course, Harvard Programs

Feel free to revive any of them.

It gets onerous wading through heaps of PhD/basic science threads to find the one non-PhD research post.

~

Other hard-won residency research/publishing lessons for the non-PhD:

Do not be afraid of taking on multiple small projects.
I don't know why I limited myself. I think it was mostly because I felt the pressure to "deliver the goods".

Mindy · Jun 4, 2007

Okay, out of respect for Deschutes, I am staying on topic (with a one-line PS diversion to Bierstiefel...)

One of the ways that I have been able to get my papers published is that I stay very focused on their completion. The steps to publication are identical, so after you put a few manuscripts in print, it becomes easier with subsequent manuscripts.

Some more writing methods I use that I've thought of:

1) Find a meeting to submit an abstract to. Everyone has their preferences, go with USCAP if you are still in the "general pathology" phase of your career. Go to your important subspecialty meeting(s) if you are differentiated. Writing the abstract will give you the bare bones of the manuscript, with a lot less commitment. Too many people look at the abstract as the product, but for me it is the starting point.

2) Prepare your figures early on. I think of the figures actually ARE the product of your work, the coat hanger the manuscript sits on. It has taken me a bit of experience to realize this, so you can see some progression of sophistication of figures from my early articles to my more recent ones. So much of the manuscript is centered on the figures.

3) Write the paper. Just sit down over a weekend and do it. Don't fret about grammar, etc. Just write it all down. Show it around to your authors, get there corrections, revise, and send it off. Bonus if it is out the door before the meeting. It is nice to say during your platform "well the manuscript will be published in blah blah blah in the next few months."

4) I actually try to do one project at a time. Or at least focus on one manuscript at a time. I can be more productive if I don't spread too thin. I guess I usually have projects waiting in the wings, so to speak, waiting for there turn in the spotlight. But, I try to make it a rule not to start a project I am not going to bother taking to completion. Why? It's a waste of my time.

Things to be careful of:

1) criticizing trademarked products. Big companies have people who look at publications for mention of their research (I have personal experience with this). They will contact you / counterattack if you attack their product (I did NOT attack their product, nor was I counterattacked, but a company did specifically inquire about a single line in one of my papers--not even in the abstract!) Just be savvy and a bit PC with your work. Make sure every sentence is justifiable.

2) People will use your work as evidence to support their work.

3) People will try to discredit your work on occasion (especially for the medico-legal oriented folks.)

4) In responding to the reviewers, address each and every recommendation they make point-by-point. If you disagree with a change, you can ask it be up to the editor's discretion, and explain why you disagree. If the changes are minor or you are not passionate about them, do what the reviewers ask, regardless of how tedious. This to me is "showing good faith" in the reviewers on your part.

4) The reviewers can be "mean". They are just trying to be good gate-keepers and sound expert in their field to the journal editor. Often the "expert" opinion is the loud, obnoxious voice who is trying to convey that they know what they are talking about. With your paper, YOU are the expert. Don't be discouraged. Use a (polite), but loud voice back in your responses if you have to. I have definitely read some reviews feeling a bit insulted. But like I said, I have ultimately never not published one of my papers. Just bite back (a little bit, and ask for the editor to intervene) if you have to.

Okay, I think I am out of hints...

Mindy

P.S. Hi Bierstiefel: I am doing well, thanks. I haven't been around much either here, but now that I am studying (theoretically) for my boards, I find I am on here quite a bit! Reminds me of med school... I haven't heard about a mixer, but I wish it would occur. I am going to be at the OCME starting in July, so may be a bit out of the loop... let me know if you hear of something! Best, M

sequela · Jun 4, 2007

Bierstiefel said:
This is very frustrating. Unfortunately, the culture in academics only serves to propagate this sort of chicanery.

See the thing is, if you go into private practice, you make much more money and you don't have to publish anything.

If you go into academics, however, you make less money. SIGNIFICANTLY LESS MONEY! And without publications, your job and salary are STAGNANT. Hence, if you ever want to improve your financial situation, you have to count on being promoted. How does one get promoted? It has nothing to do with whether you sign out 10000 prostate cores vs. 5000 prostate cores. It has to do with how many papers you publish. Hence, the junior attendings are under constant pressure to publish to get promoted for a modest but significant increase in salary.

i see what you're saying. and i think the culture of academics needs a make-over. it's unfortunate that this pressure exisits but as i had suggested in my earlier post, it is exactly this sort of pressure that is likely to push production, with or without quality. and maybe that's not the case at bwh or mgh but that is likely happening elsewhere and in other fields as well. i by NO means am suggesting that 99% of what's out there is crap (that's too big a percentage in my view) or that preliminary findings/observations or non-ground-breaking work need not be published (of course it needs to start somewhere and progress is most certianly incremental). i am just pointing out that sometimes and in some instances (ie getting fellowships for example), the publishing craze is more political than it is about enriching our understanding of disease. i don't know why this perspective caused such a reaction...no where do i suggest that projects should not be undertaken or that they are of little value to your general training. of course they enrich your learning experience!!!! of course they broaden you skill set!!!! and yeah, most often than not they add to the body of literature. that still doesn't mean that the primary motivation (for some) is all about furthering science. that's all i am saying and from what you've written in your post regarding faculty positions, it doesn't seem that far off.

perhaps it's merely a matter of survival but to deny this element is a bit naive. and i say this as general commentary, not as an accusation toward anyone person on this board.

as far as the bwh vs mgh goes, as someone who interviewed this year at both places, i can tell you that both programs went out of their way to eliminate that long-held perspective. i was convinced anyway.

LADoc00 · Jun 4, 2007

This I appreciate more and more since making the personal decision to no longer pursue a career in pure basic science research (i.e., this bierstiefel will not be doing a postdoc).

Wow. Is that a new newsflash??

Welcome to the darkside....

deschutes · Jun 4, 2007

Thanks Mindy! I feel like I learnt more about the "big picture" of research project completion from two of your posts than all the muddling I did through med school and residency 🙂

Just to clarify for those following the discussion, when I said "take on multiple projects", I meant having variety, like a case series here and a case report there, with different attendings. Because sometimes projects stall, and for practical purposes you can then keep moving forward with another project.

That's my amateur's take anyway.

BU Pathology · Jun 4, 2007

docbiohazard said:
So, this is a question I probably need to post over in the MD/PhD forums, but as it is specific to Pathology and this thread has meandered in that direction, I thought I'd go ahead and post it here (if it's too much of a threadjack, I apologize in advance)...

As an MD/PhD interested in a career in academic pathology, I'm looking at programs trying to decide how "research oriented" a residency or tract I want to pursue. The classic dichotomy I've read about on here would be MGH v. BWH, at least in terms of reputation in the past, that MGH breeds top notch diagnosticians where BWH is more oriented towards breeding top notch research oriented pathologists.

My question is, as I've already devoted 4 years of my life to research training and my PhD, should I be focusing on finding the best clinical/diagnostic education experience I can find, or should I go on a more research oriented tract to allow me to "keep up my skills" in the research world, publishing, and the like? I've asked some faculty I know and I've gotten a slew of answers kind of across the board, just curious about the residence experience.

The third option would be a residency with a "research track" (like the SPLIT program at MGH), however there again, I can't decide if that's really designed more to train someone with an MD who decides they're interested in research, and would be somewhat redundant for an MD/PhD. My turnoff with that program (and others) is that they seem to require you to pick either AP or CP to board in, and I'd prefer to go AP/CP (although I notice in some cases there appear to be AP/CP residents in those programs)...

Just curious for the thoughts of any MD/PhD residents, or research/academic oriented path residents, and what they might think.

Best regards,
BH

Allow me to put in a shameless plug for another Boston pathology program, Boston University. We have a brand new building, a brand new chair (me), and a renewed commitment to excellence in both diagnostic work and research. Mentoring is a critical component of residency training whether you are doing diagnostic work or basic science investigation. Teaching and mentoring are highly prized parts of the annual review by the faculty here at BU, and it is possible to be promoted solely on the merits of your teaching portfolio. Please consider Boston University for your pathology training (we need to develop a catchy tagline here to close out the pitch).

Dan Remick, Chair, Department of Pathology Boston University

LADoc00 · Jun 4, 2007

sequela said:
i see what you're saying. and i think the culture of academics needs a make-over.....i am just pointing out that sometimes and in some instances (ie getting fellowships for example), the publishing craze is more political than it is about enriching our understanding of disease..

QFT. I would add to this that academics as we now know it is in its death knell. I see massive changes in store for higher education and medical schools in general.

Things on the horizon:
Continued banking crisis due to mortgage fall out
Declining home prices to the point of general recession
Bankrupt social security and medicare systems
Forced one payor model of health care delivery
Continued decline of the value of the dollar
Massive demographic changes, this will be unheralded in human history, read Gray Dawn or Coming Generational Storm for more.

quant · Jun 4, 2007

LADoc00 said:
Things on the horizon:
Continued banking crisis due to mortgage fall out
Declining home prices to the point of general recession
Bankrupt social security and medicare systems
Forced one payor model of health care delivery
Continued decline of the value of the dollar
Massive demographic changes, this will be unheralded in human history, read Gray Dawn or Coming Generational Storm for more.

Hmmm......

Resident research and publishing

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