Basic vs. Clinical Research

[Adcadet]

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Great new forum! Thought I'd start a conversation. Just wondering if any of the peeps here have thoughts on basic vs. clinical research (yeah, kindof a crude distinction, but I think it's useful). Do you think both are equally appreciated by those in power and those who look at our CV's? Do you prefer doing one over the other? If you're doing one or the other, do you plan on switching in the future? Think one type is better for premeds, med students, residents and fellows?

 

[Sophie]

My preference is clinical research, but I do think basic research looks more impressive and is better for pre-meds and med students to do. It also seems a lot more difficult.

With that said, there's no way I'd ever switch to basic research. I did enjoy my lab classes, and was fascinated by the different techniques we did, but the best part of all of my labs was working with my classmates. I'm sure a lot of collaboration goes on in basic research, but you don't work with people to the same extent as you do in clinical research. I love interacting with patients, research assistants, nurses, doctors, etc, on a daily basis. I also like that even though I'm not discovering some amazing cure for something, I am making a big direct impact on numerous people. For example, I'm doing a smoking cessation study right now, so each of the thousands of participants is directly benefiting, even if the study findings aren't compelling enough to turn this into an established, non-research, clinical program once the study ends.

 

[Adcadet]

I have a hypothesis that clinical research and epidemiology are at a disadvantage because they are not taught at the undergraduate level and people don't have the chance to do this type of research in college. Thus, those that do engage in clinical/epi research (usually in grad school or post-college) face a general lack of appreciation and understanding, and sometimes a stigma that they couldn't handle "real" (basic) research. Thus, I generally agree with Sophie that undergrads (and younger students in general) should work on getting some basic science research under their belt so that if/when they do clinical/epi work there's less opportunity for others to ding them for not doing "real" research for whatever reason. Sort of like getting your stripes by working in a lab, culturing cells, working with rats, pipetting, autoclaving, etc.

Just my hypothesis. Not well-formed at this point. I welcome comments, criticism, etc.

 

[fantasty]

I have a hypothesis that clinical research and epidemiology are at a disadvantage because they are not taught at the undergraduate level and people don't have the chance to do this type of research in college. Thus, those that do engage in clinical/epi research (usually in grad school or post-college) face a general lack of appreciation and understanding, and sometimes a stigma that they couldn't handle "real" (basic) research. Thus, I generally agree with Sophie that undergrads (and younger students in general) should work on getting some basic science research under their belt so that if/when they do clinical/epi work there's less opportunity for others to ding them for not doing "real" research for whatever reason. Sort of like getting your stripes by working in a lab, culturing cells, working with rats, pipetting, autoclaving, etc.

Just my hypothesis. Not well-formed at this point. I welcome comments, criticism, etc.

I think those are really good points. I really had no interested in lab research during undergrad, and I really had to look for opportunities to do more "patient-oriented" research. This meant I did have to search for upper level undergrad and even grad courses to learn epidemiology and biostats. And, while I have a lot of respect for my basic science MSTP colleagues (awe, actually - I'm impressed in how basic scientists think).

I don't, however, feel the same respect back (although this is mostly from faculty, not the students). Students seem to shrink away from the quantitative aspects and at least give me props for taking so many stats classes). As an example, we had a panel talk at our annual MSTP retreat this summer regarding clinical research. The docs covered an array of disciplines and types of clinical research. But, one guy tried to give an overall summary of clinical research. He explained that conducting good clinical trials takes years and millions of $ and is a huge undertaking. Then, he said "but you can do throw together an epidemiology study in a long weekend." 😉 Lovely - I'm glad I've been fighting with my dissertation for 8 months - I'm glad to hear his well-informed perspective.

But, I'm glad to say that I've gotten over this. My suggestion is to go with your strengths and interests. Once decided, go full force and don't apologize or second guess. In the end, we need good researchers doing both basic and clinical, and very few are going to be doing both. So, pick your niche and do your best.

 

[Adcadet]

As an example, we had a panel talk at our annual MSTP retreat this summer regarding clinical research. The docs covered an array of disciplines and types of clinical research. But, one guy tried to give an overall summary of clinical research. He explained that conducting good clinical trials takes years and millions of $ and is a huge undertaking. Then, he said "but you can do throw together an epidemiology study in a long weekend." 😉 Lovely - I'm glad I've been fighting with my dissertation for 8 months - I'm glad to hear his well-informed perspective.

Wow, that's great. 😡 I'm amazed at home some people can be so involved in biomedical research (read: basic research that might have some medical application in a decade), yet are so clueless about epi stuff. Not that there isn't some grain of truth to his statement. I'll admit, there are some studies you can do over a long weekend....if you have already planned the study....if you already have the data....if you know what stats you need to run, how to run them, how to interpret them...etc.

I've always thought that I'd prefer to do stats with a great psych researcher than a great biology researcher. Why? Who's got to know stats better? In my undergrad the most complicated stats I saw was in developmental psychology. I'm not sure I ever saw anything beyond T tests and ANOVA in all my immunology and neuroscience classes.

</rant> </soapbox> That said, the MSTPers in my class that I got to know have a healthy dose of respect for epi. So there's hope.

 

[size_tens]

IMO the successful basic science guys deserve to be considered the top guns of research. While I realize that epidemiology/clinical studies can involve a great deal of work, it really doesn't compare to the kind of creativity and persistence necessary in basic science. Anyone who has spent any amount of time in the lab knows that novel experiments rarely work out as you planned. It's possible to spend years doing basic science research without a publication to show for it. On the other hand a randomized control trial of just about anything is pretty much guaranteed to produce publishable data.

 

[Adcadet]

IMO the successful basic science guys deserve to be considered the top guns of research. While I realize that epidemiology/clinical studies can involve a great deal of work, it really doesn't compare to the kind of creativity and persistence necessary in basic science. Anyone who has spent any amount of time in the lab knows that novel experiments rarely work out as you planned. It's possible to spend years doing basic science research without a publication to show for it. On the other hand a randomized control trial of just about anything is pretty much guaranteed to produce publishable data.

Good points, but on the other hand what kind of research contributes more to clinical medicine? Not exactly an apples-to-apples comparison (by definition), but I think your average published epi study has a lot more to do with changing clinical practice than your average basic science study (and therefor those who do change clinical practice through basic science definitely deserve kudos).

Would you rather your endocrinologist be in the middle of completing a large RCT or in the middle of a study of the molecular genetics of Type I diabetes? The former, almost by definition needs to understand current clinical practice, whereas that's not necessarily true with the later. I would like to argue that those doing clinical research must have a better understanding of clinical medicine as it's practiced today, since their lab is the clinic. Also, those doing clinical research are in a much better position to be able to evaluate the applicability of new research. Now, perhaps MD/PhDs who run labs and spend a significant amount of time doing clinical work could also claim this.

If you were a program director, would you be more inclined to rank highly an applicant with significant basic science research experience, or an applicant with significant clinical research experience? I would lean more towards the one with clinical research experience, since that's (a) easier to continue in residency, (b) be more applicable to the resident's "day job", and (c) much more likely to contribute to the practice of medicine in a tangible way in my lifetime.

 

[size_tens]

Good points, but on the other hand what kind of research contributes more to clinical medicine? Not exactly an apples-to-apples comparison (by definition), but I think your average published epi study has a lot more to do with changing clinical practice than your average basic science study (and therefor those who do change clinical practice through basic science definitely deserve kudos).

Would you rather your endocrinologist be in the middle of completing a large RCT or in the middle of a study of the molecular genetics of Type I diabetes? The former, almost by definition needs to understand current clinical practice, whereas that's not necessarily true with the later. I would like to argue that those doing clinical research must have a better understanding of clinical medicine as it's practiced today, since their lab is the clinic. Also, those doing clinical research are in a much better position to be able to evaluate the applicability of new research. Now, perhaps MD/PhDs who run labs and spend a significant amount of time doing clinical work could also claim this.

If you were a program director, would you be more inclined to rank highly an applicant with significant basic science research experience, or an applicant with significant clinical research experience? I would lean more towards the one with clinical research experience, since that's (a) easier to continue in residency, (b) be more applicable to the resident's "day job", and (c) much more likely to contribute to the practice of medicine in a tangible way in my lifetime.

Well yes of course clinical research has a greater immediate impact on contemporary medical practice. It's definitely important for addressing specific questions like "should I perscribe drug A or B?". The effects of basic science research on clinical practice are usually more for the long term and less direct. For example, working out the regulation of a transport protein would not influence medical practice straight off, but could lead to a new drug. I can't say which type of research is looked upon more favorably by program directors. At good academic institutions abundant oppurtunities in both are available and I would think that a solid first author publication in any type of biomedical research would be taken pretty favorably.

 

[jojo14]

I can't say which type of research is looked upon more favorably by program directors.

I can't either, but I would think it would vary with each specialty. For instance, derm pd's may be more impressed with basic science research on some type of skin cell. Something like family practice or emergency medicine lends itself better to clinical research (ok, this crazy guy is in my face, what is the best sedative to give in the ED with respect to efficacy and safety profile?) But I know both of those specialities have basic science research as well.

I think if you are a first author on either kind of paper in med school, a pd should be impressed! Lots of people don't have this distinction.

 

[ski_bum]

Interesting discussion.

Personally, I can't stand basic science research. Bores me to death.

That's why I'm so glad there are other dedicated people out there who excitied by it.

To each their own.

 

[PhDtoDO]

I'm in basic lab research and I have a masters in public health...taken stats and epi and read all of it for my work.

Regarding Clinical vs. Bench(as I call it), clinical can be much easier to get out (publish) in one respect. You can throw together a study and the lesser journals can be easier to publish in. Now, there are the cohort studies, etc that are millions and years...but they are really really important and sort of fall in a unique separate category. And there's everything in between. As a bench person, we collaborate with MDs all the time and some PIs try to keep those smooze channels open by putting the MDs on their papers even if all they did was show up to a meeting every month and throw some human biopsies our way. It's not suppose to work like this but it does sometimes.

I love my research, HIV etc, but I'm at a burn out stage and want to shift into clinical. I will be at a huge advantage with my bench background. I understand how to read it, plan it, and communicate in lab speak. My public health is more from classes and interest, but I can work the epi thing too with a good collaboration in the future.

For new people, I suggest the bench. Get a taste for it. Then if you don't like it, at least you'll appreciate it and understand it better when you move on. It's easy to get an undergrad paying lab job working on the bench...learn, if you don't like your lab...try another one, I did this after my first year working in a lab...then the PI left and I spent a year doing animal work. Then I asked for a project, and became a pet of a senior grad student...loved it, was totally bitten.

And if you know anything, epi is the most important and most unappreciated field in medicine. Trust me, this is a motto for those on the in.

Clinicals vs. Bench papers....depends on the paper and everyone is biased. Bench people can judge bench papers and know how easy some clinical papers are, but they can also see some real quality. MDs tend not to appreciate bench papers as much because they may not understand them...trust me I've been to mostly MD meetings and the critiques on my work could be laughable. PhDs, no joke, tend to be more dexterous and have higher IQs...not my opinion, a fact.

BUT....many if not most Deans of Admissions are PhDs. And the people who teach the basics in med school and covet those Administrative Hats sitting on med school committees are PhDs.

I don't know for sure, but I'd bet that if someone counted most of the 'doctors' that actually read med school applications, they are PhDs...not MDs.

Sorry for running on.


-s

 

[Scottish Chap]

Great new forum! Thought I'd start a conversation. Just wondering if any of the peeps here have thoughts on basic vs. clinical research (yeah, kindof a crude distinction, but I think it's useful). Do you think both are equally appreciated by those in power and those who look at our CV's? Do you prefer doing one over the other? If you're doing one or the other, do you plan on switching in the future? Think one type is better for premeds, med students, residents and fellows?

I have seven years of experience in bench research and two in clinical research. I'll be honest and say that it's really the M.D. and Ph.D. bench researchers that get most of the glory and it's not clear to me why that is. Of course, doing basic, bench studies is harder at the 'back end' (carrying out the experiements and getting published) but, at the 'front end', clinical research is more challenging.....obtaining IRB approval for even procuring clinical specimens is no joke! In terms of getting the work published - my clinical research papers were published one year after the work began while my basic research work took three times longer to trouble-shoot, execute, and publish. It was much harder overall. There is a place for both of them and I'm pleased to see hard working, commited individuals in both basic and clinical/translational research. Bottom line: you can't be all things to all people and it's best to do what you enjoy most.

 

[Hurricane]

If you were a program director, would you be more inclined to rank highly an applicant with significant basic science research experience, or an applicant with significant clinical research experience? I would lean more towards the one with clinical research experience, since that's (a) easier to continue in residency, (b) be more applicable to the resident's "day job", and (c) much more likely to contribute to the practice of medicine in a tangible way in my lifetime.

There's more to it than that. They are also interested in what you plan to do after residency. Some fields, such as psych for example, are hungry for more basic science researchers, and so the more academic programs are very excited about applicants with basic neuroscience research experience who plan to continue in that direction.

IMO it doesn't really matter which is "better." We need people doing both.

 

[gasoos03]

thanks for it

 

[gasoos03]

thanks

 

[Medarca]

Great new forum! Thought I'd start a conversation. Just wondering if any of the peeps here have thoughts on basic vs. clinical research (yeah, kindof a crude distinction, but I think it's useful). Do you think both are equally appreciated by those in power and those who look at our CV's? Do you prefer doing one over the other? If you're doing one or the other, do you plan on switching in the future? Think one type is better for premeds, med students, residents and fellows?

To my mind, there's no great difference between these two things. And maybe during our investigation we should not compare them. As for me, basic research is STEP 1, and clinical - STEP 2. I don't like to approach to the patient withou beeng sure in what I do. On the other side - basic research without clinical trials - are useless. As for me, the best way is to combine them.

 

[Drogba]

I have a hypothesis that clinical research and epidemiology are at a disadvantage because they are not taught at the undergraduate level and people don't have the chance to do this type of research in college. Thus, those that do engage in clinical/epi research (usually in grad school or post-college) face a general lack of appreciation and understanding, and sometimes a stigma that they couldn't handle "real" (basic) research. Thus, I generally agree with Sophie that undergrads (and younger students in general) should work on getting some basic science research under their belt so that if/when they do clinical/epi work there's less opportunity for others to ding them for not doing "real" research for whatever reason. Sort of like getting your stripes by working in a lab, culturing cells, working with rats, pipetting, autoclaving, etc.

Just my hypothesis. Not well-formed at this point. I welcome comments, criticism, etc.

What makes you say you can't participate in epi projects as an undergrad? Many colleges offer courses in epidemiology, biostats and a variety of quantitative and qualitative research methods that are applicable to health care research. I personally am an undergrad that opted out of doing lab work. I could opt in now if I wanted but it would be at the expense of the meaningful and far more interesting (in my opinion) research that I am working towards now. There are fields of medicine that value this above basic science. The interphase between public health and medicine for example. There are many "social medicine" programs that offer combined md/mphs as well as md/phds in the social sciences. Why not focus on what you are interested in? I don't think any of the MD/PhDs from the social medicine dept at harvard are getting "dinged" for not doing "real research," but my perspective is obviously relatively narrow due to my stage of education.