Research vs the Great Clinician

[raspberry009]

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One thing that I have noticed is how much emphasis has been put on research during residency. Don’t we have the rest of our lives to work on our CVs but only a small window to learn pathology under the protection of our superiors. I would much rather be reading up on breast biopsies than coming in on the weekend and doing research.
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Whatever happened to being a great clinician?? It seems like there are so many folks out there that are good at research but really suck at the scope, but they are the ones that will get the job because they look good on paper.
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I would much rather spend my time reading and looking at slides than doing research. I feel like this time is too precious to wasting on publications. But I must digress because publications do look better on paper and I don’t want to be out of a job.

 

[2121115]

One thing that I have noticed is how much emphasis has been put on research during residency. Don’t we have the rest of our lives to work on our CVs but only a small window to learn pathology under the protection of our superiors. I would much rather be reading up on breast biopsies than coming in on the weekend and doing research.
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Whatever happened to being a great clinician?? It seems like there are so many folks out there that are good at research but really suck at the scope, but they are the ones that will get the job because they look good on paper.
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I would much rather spend my time reading and looking at slides than doing research. I feel like this time is too precious to wasting on publications. But I must digress because publications do look better on paper and I don’t want to be out of a job.

When people who are smart and hardworking are presented with the opportunities to both publish research and become competent diagnosticians they will, as a general rule, do both well. This is why the two are often correlated and why it matters in future employment prospects.

I do think though, that this rule applies more at large academic programs where research opportunities abound. Obviously, if you are at a program where nobody is doing research and it is hard and arduous to even put together an abstract with attending approval, then yes it is probably not worth your time to set up your own research in residency when you could be reading.

However, I don't know any of these people who "suck at the scope" but are "good at research". I do know a lot of people who are smart, motivated and hardworking though and these people are both good at research and good at the scope.

 

[KCShaw]

Some "research" is, I think, a natural part of becoming a good clinician. Taking the time to turn your impromptu literature review of the value of metabolic studies in the autopsy setting (or, insert your own relevant situation) into a publishable paper is another matter. The majority of practicing clinicians don't seem to publish on a regular basis, though they may throw out some case reports and that sort of thing from time to time, so I can see why anyone would question the utility of publishing in residency when there is so much else to learn that WILL be used on a regular basis. Yeah, in part it's just another way to separate job applicants. And in part it's paying back your specialty's community by adding to the greater pool of available information. But I also think it's another way the average academic department running a residency program helps its attendings continue to publish (which translates into prestige and potentially outside funding), which may be a requirement of their own employment -- get the residents involved.

Yeah, some people have an odd knack for publishing. And some people really enjoy it. But honestly, if someone truly sucks at the clinical side of the job.. ultimately they're not going to be doing it. I think the opposite is also true -- those who excel at the clinical side of the job and avoid publishing like the plague can still certainly have a very good career. It just may be a little harder to get noticed early on.

 

[oldfatman]

Yeah, some people have an odd knack for publishing. And some people really enjoy it. But honestly, if someone truly sucks at the clinical side of the job.. ultimately they're not going to be doing it. I think the opposite is also true -- those who excel at the clinical side of the job and avoid publishing like the plague can still certainly have a very good career. It just may be a little harder to get noticed early on.

You may also get sucked into a case report project out in private practice, so it helps to have some idea of how the process works.

 

[lipomas]

There is this odd sort of mythology amongst some residents who hate doing research that they are somehow better at clinical stuff and diagnostic stuff because they have "more time to devote" to it. In almost all circumstances this is false. The residents doing the projects and the research, in addition to spending all that time on the projects, also spend more time on education and diagnostic skills. I am not sure where this mythology comes from but I suspect in some cases it is related to work ethic.

Evidence for this is pretty solid: If you go to many larger programs, the best residents diagnostically are also often the ones who have more projects. Of course, there are always exceptions. There are residents who care about projects but don't care about diagnostics. There are exceptional diagnostic residents who hate doing projects and refuse to participate. But if I was hiring people I would tend to be wary of residents who had zero projects. It tends to show a lack of initiative, a lack of critical study of something in detail, and other similar qualities.

Contrary to what was said above, I do know people who are good at research but suck at the microscope. These are generally basic science people though, and not clinical researchers who write articles for AJSP and book chapters and such.

Good luck with getting to convince people that your lack of time doing projects and research has all been devoted to making yourself a better pathologist. It's not an either-or proposition. As I said, that is unfortunately something that all kinds of people say.

I did a couple of projects in residency. I didn't really like doing them but it did teach me a lot about various things that are applicable to pathology. I knew that I didn't want to make a career out of it though.

 

[Pathwrath]

The trend in current academic pathology is the boutique pathologist who has mastered the single organ system (or perhaps ultimately only a small part of a single organ system). Ever-expanding resident research plays a big role in this. It sucks away time otherwise spent getting a functional handle on general surgical pathology and increases resident anxiety about his or her sign-out ability, making subspecialty fellowship and boutique practice a relief.

 

[KCShaw]

It's also kinda discouraging when the only face time with certain attendings is spent on isolated research projects at the expense of teaching the bigger picture. Personally, the few residents I know/knew who were really dead set against getting involved in research were also kinda down on the primarily-research attendings, and I think didn't want to be forced to turn into them one day.

I was kinda lucky in the grand scheme of things to have been exposed to only rare attendings whose lives revolved around research at the expense of teaching (maybe you know the ones -- you have one short rotation with them and on day one they give you a project and send you to the resident offices where you spend the next few weeks, and never get exposure to the rotation you're supposed to be doing), and several who seemed to balance it very well (hopefully you know more of these -- partway through working with them you ask them a question they can't answer, and you both figure out it's not well described in the literature, and next thing you know you're done with something publishable).

Personally, research projects per se can be rather interesting. Taking the extra time to make it publishable and go through the strangely mandatory process of rewriting after initial submission and review...not so much. Would I rather have spent time reading up on breast biopsies than feel like I had to spend weekends working on research projects? In general, yep. But I do understand some of the utility, too.

 

[lipomas]

The trend in current academic pathology is the boutique pathologist who has mastered the single organ system (or perhaps ultimately only a small part of a single organ system). Ever-expanding resident research plays a big role in this. It sucks away time otherwise spent getting a functional handle on general surgical pathology and increases resident anxiety about his or her sign-out ability, making subspecialty fellowship and boutique practice a relief.

I do agree with that. The other point that should be mentioned, however, is that these same people you mention also write boards questions! And there definitely are residents who get so sucked up in projects, often many with the same attending, that they do not learn general skills. Patch that in with a program that gives minimal preview time or otherwise graduated responsibility and you have a fairly useless residency graduate.

 

[yaah]

People have already said what I would say - good researchers are quite often excellent clinicians. It's not an either-or proposition. Most of the best diagnostic residents also participate quite a bit in research. There are distinctions - people who end up being great bench researchers often do minimize their diagnostic time, but not always.

 

[pathstudent]

IMO the great researcher and great clinician and great teacher are synonymous. Think about Odze, Fletcher, or Chris Lee. All great teachers and researchers but also kick ass diagnosticians. Who sends who the consults? Does the person that only focused on diagnostics and then went to medium sized community practice hospital send Odze the consults or does Odze send them to him? things that make you go HMMMMMMM

 

[ScotchBonnet]

This is just my opinion, and others may disagree. I think that when talking about great clinicians who are great researchers, it is important to specify the type of research you mean. Specifically, I think there are many great clinicians who turn out clinically-oriented research. The number of basic/bench researchers who do any significant clinical work I can think of, on the other hand, is very low. Take for example the prostate/GU system. Someone like Epstein at Hopkins is known as an expert diagnostician and publishes work about clinical outcome, correlation between biopsy and resection, etc. in journals like ASCP. Compare that to someone like Chinnaiyan at Michigan who publishes genetic studies in journals like Nature but does zero clinical work (to my knowledge). In short, I think great clinicians naturally are able to generate clinical publications since they are an extension of their day-to-day practice and heavy consult practice. Being great at the microscope and in the basic science lab is a whole different ballgame though.

 

[multiplemyeloma]

Chinnaiyan is a urologist, not pathologist🙂 just sayin..

 

[oldfatman]

IMO the great researcher and great clinician and great teacher are synonymous. Think about Odze, Fletcher, or Chris Lee. All great teachers and researchers but also kick ass diagnosticians. Who sends who the consults? Does the person that only focused on diagnostics and then went to medium sized community practice hospital send Odze the consults or does Odze send them to him? things that make you go HMMMMMMM

You're going to get mauled in general private practice.

 

[path19]

IMO the great researcher and great clinician and great teacher are synonymous. Think about Odze, Fletcher, or Chris Lee. All great teachers and researchers but also kick ass diagnosticians. Who sends who the consults? Does the person that only focused on diagnostics and then went to medium sized community practice hospital send Odze the consults or does Odze send them to him? things that make you go HMMMMMMM

i think you're missing the point. of course there is a select group of academic pathologists who are great at every aspect of pathology. but these individuals are extremely talented and naturally gifted. not everyone is that gifted, and the real issue is whether an average pathology resident out there should spend their time learning pathology or doing research. the bottom line is, research is usually very time consuming and time is a limited resource in residency, particularly for those with children or other outside of work committments. while in an ideal world you could do it all, i'm just not sure that's realistic for everyone. what is most important is to become competent signing out cases. if you can do this and still have time for research, that's great. if you can't, by all means see more cases and read about them instead of writing abstracts or papers. i think the number of academic patholgists with questionable diagnostic ability (and only mediocre research efforts) attests to the fact that i'm right about this one - not very many individuals can do it all well.

also, i know of a few pathologists who are currently or who have in the past practiced in the private setting who are superior diagnostically to the great majority of academic pathologists. the reason why the academics get the consults is largely becuase clinicians (and patients) aren't in a position to recognize who is or isn't a good diagnostic pathologist and therefore require an institutional name brand behind a controversial or unusual diagnosis.

 

[BU Pathology]

Chinnaiyan is a urologist, not pathologist🙂 just sayin..

Dr. Chinnaiyan is the Hicks Professor of Pathology and Director of Informatics, board certified in pathololgy. He does GU research, but he is a pathologist.

 

[deleted57552]

Dr. Chinnaiyan is the Hicks Professor of Pathology and Director of Informatics, board certified in pathololgy. He does GU research, but he is a pathologist.

Brilliant guy!

 

[Gyric]

also, i know of a few pathologists who are currently or who have in the past practiced in the private setting who are superior diagnostically to the great majority of academic pathologists. the reason why the academics get the consults is largely becuase clinicians (and patients) aren't in a position to recognize who is or isn't a good diagnostic pathologist and therefore require an institutional name brand behind a controversial or unusual diagnosis.

Having sat on some big name consult services I can't say that I agree. It is fairly obvious when a clinician is twisting the local pathologist's arm to send off a case for a second opinion for the reasons you mention. In my experience the submitting pathologist is most often uncertain of the diagnosis and requires an expert opinion. It goes without saying that providing good patient care requires that you send consults to someone you trust (and the fact that using a consultant does not always get you off the hook in a lawsuit), academic vs the private setting is less important.

 

[2121115]

...the real issue is whether an average pathology resident out there should spend their time learning pathology or doing research.

I think the point is that for a resident who is competing with other residents for a job, it matters a lot when all other things are equal. Let's say you are hiring a hematopathologist. Two recent trainees apply and one has published in hemepath while the other has not. Even if the one without publications has spent more time reading and/or at the scope during the time the other spent writing no one believes that. They assume that the one who was not publishing just went home while the other resident worked harder. Most residents' CVs are indistinguishable except for the name of the program where you trained and publications/abstracts presented at conferences. It is foolish to not take the opportunity to publish when it is one of the relatively few ways to distinguish yourself as a resident.

 

[path19]

I think the point is that for a resident who is competing with other residents for a job, it matters a lot when all other things are equal. Let's say you are hiring a hematopathologist. Two recent trainees apply and one has published in hemepath while the other has not. Even if the one without publications has spent more time reading and/or at the scope during the time the other spent writing no one believes that. They assume that the one who was not publishing just went home while the other resident worked harder. Most residents' CVs are indistinguishable except for the name of the program where you trained and publications/abstracts presented at conferences. It is foolish to not take the opportunity to publish when it is one of the relatively few ways to distinguish yourself as a resident.

I agree with you 100%. It is an unfortunate (or fortunate I guess depending on your point of view) reality that trainees in pathology often need to do research to succeed in the field, even if one's definition of success is a good private practice job. And I think pathology is somewhat unique in this respect. That's just the way it is unless you have good connections to a job which will likely trump just about anything else on your CV. I guess I was just trying to say that I think this is unfortunate because I have seen pathologists do research and publish but have major diagnostic weaknesses once they're practicing. I personally spent an entire elective month doing research for the reasons you mentioned above, but I certainly would have liked to brush up on some of my weaker areas instead.

 

[pathstudent]

I think the point is that for a resident who is competing with other residents for a job, it matters a lot when all other things are equal. Let's say you are hiring a hematopathologist. Two recent trainees apply and one has published in hemepath while the other has not. Even if the one without publications has spent more time reading and/or at the scope during the time the other spent writing no one believes that. They assume that the one who was not publishing just went home while the other resident worked harder. Most residents' CVs are indistinguishable except for the name of the program where you trained and publications/abstracts presented at conferences. It is foolish to not take the opportunity to publish when it is one of the relatively few ways to distinguish yourself as a resident.

Yes you are right the little things matter. When all is equal, having gone to Harvard for medical school, having done an MD/PhD, or having done residency at an elite program (Bwh, mgh, jhu, ucsf or stanford) means all the world.

Trust me even a tiny community path group would shoot their wad if they could get a JHU trainee just for the fact that they could tell all the clinicians that their new is from JHU. The power or academia is immense.

Also it is important to mention that doing a research project can basically make you an expert in that area.

 

[multiplemyeloma]

Dr. Chinnaiyan is the Hicks Professor of Pathology and Director of Informatics, board certified in pathololgy. He does GU research, but he is a pathologist.

my bad...😳

 

[yaah]

Trust me even a tiny community path group would shoot their wad if they could get a JHU trainee just for the fact that they could tell all the clinicians that their new is from JHU. The power or academia is immense.

Huh? That doesn't make any sense. Academic credentials are a secondary asset, at best.

 

[raspberry009]

All of you have valid points. I must say I was very frustrated the day that I started this post. But I do think I was frustrated for a reason.

Us residents only have a small amount of time is residency to see as much as we can. I feel that my time would be better used become as great as a pathologist as I can right now rather than trying to get research out and published. I want to stay in acedemics, but I've been told that publications are really what make you stand out.

I feel that at this time in my career I need to focus on becoming a great diagnostisian. I have the rest of my career to put out publications.

 

[KeratinPearls]

Huh? That doesn't make any sense. Academic credentials are a secondary asset, at best.

Agree clinicians can care less where you trained. Just as long as you are competent and can give them answers and can communicate thats all they care about.

 

[zao275]

Also it is important to mention that doing a research project can basically make you an expert in that area.

This is actually a good point, especially if your area of research is a tiny niche subject or rare entity.