Research

[ninerdude82]

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I'm starting medical school Fall 2007 as a part of my 7 yr BA-MD program. I have not done any research my first 2 years of the programs. I realize that if I want to get into good residencies after medical school, I have to plan and start early. To have a more specific plan, my goal is to get into a good surgical residency program. So I have two questions..

1) What can I do now that will help me be a more competive candidate when applying to residency programs?

2) What kind of research should I be looking for and how do I go about searching for these research positions? (i.e. who do I email and what should be said in these emails)

~Thank you

 

[Pinkertinkle]

I'm starting medical school Fall 2007 as a part of my 7 yr BA-MD program. I have not done any research my first 2 years of the programs. I realize that if I want to get into good residencies after medical school, I have to plan and start early. To have a more specific plan, my goal is to get into a good surgical residency program. So I have two questions..

1) What can I do now that will help me be a more competive candidate when applying to residency programs?

2) What kind of research should I be looking for and how do I go about searching for these research positions? (i.e. who do I email and what should be said in these emails)

~Thank you

Surgical residency as in gen surgery or as in orthopedics/ENT/etc?

1) You want to build a whole package of high grades/evals, high step 1 score, good letters of rec and good research. Research experience in your specialty of interest will help with the last 2.

2) Try to find a reasonable (middle) sized lab in the specialty of your interest. Too big is bad because you'll never get to work with the professor. Too small is bad because there's nothing going on.

Basic science is valued the most but often the most difficult to get done. In my mind the research hierarchy goes:
basic science> clinical research>case reports> nothing.

also:
first author>second author>middle authorships> nothing

 

[nyudoctor22]

1.) I've also heard that pure research is better than clinical research but I have not learned why. Does anyone know?

2.) How much time does one have in medical school to research?? The only time I can think of is the summer between M1 and M2. The summer between M2 and M3 is USMLE and there really isn't a summer between M3 and M4. Researching during the school year has to be brutal if even possible. So my question is ... how much research is enough?

 

[nyudoctor22]

Anyone? Please...

 

[soeagerun2or]

Clinical research is better than basic science research. The biggest reason for this is that generally PhDs do basic science and MDs do clinical reasearch and when it comes down to it MDs know MDs which helps in applying for a residency because the program will have heard of the guy you've done research with or at least recognize that he is in the same field.

You have as much time as you want to do research. If it is something you actually enjoy you do it in your free time instead of watch TV, play video games, or do whatever else you would. This, however is relatively rare. Most people only do research to get a letter out of it, get published, or put it on their CV so they burn out and hate it and avoid any serious effort to do it.

 

[nyudoctor22]

The plot thickens. Now there are contrary opinions...

 

[Pinkertinkle]

Clinical research is better than basic science research. The biggest reason for this is that generally PhDs do basic science and MDs do clinical reasearch and when it comes down to it MDs know MDs which helps in applying for a residency because the program will have heard of the guy you've done research with or at least recognize that he is in the same field.

The biggest guys in respective medical fields are the MD's or MD/PhD's with basic science labs and at least 2 or 3 R01 NIH grants. Basic science research is what brings in the big money to medical schools and boosts their ranking respective to their peers. This is why it's valued. Clinical research is mostly chart reviews and some such that involves mostly reading charts and plugging in numbers. Snore.

When you are applying to residency at big name academic institutions, among other things they are also evaluating you for potential as future faculty. Publication record is very important in this, and you can bet having your name on basic science papers is more impressive than chart review and case report (cuz basic science brings the big bucks for the dept).

 

[soeagerun2or]

basic science brings the big bucks for the dept.

False. Most basic science is conducted outside clinical departments. While many clinical departments do have R01 sponsored research the much more lucritive field of clinical trials for drug and isntrument is the real cash cow for departments. On residency interviews NEJM/JAMA >> Nature/Science

 

[vtucci]

It depends on your bias. The best research is the kind that you are going to enjoy. My mentor (in emergency medicine) has told me that if a medical student gets one publication that is considered excellent. If they have more than one publication, that is outstanding. The easiest way to get publications is in the clinical research arena (as opposed to basic science research-- any good basic science research will take at least a year normally) so you can do case reports, case series, lit reviews. RCTs are the best but very hard to get into because of funding issues at alot of places (this is where checking into a research mentor with an established lab- there are clinical labs in the hospitals).

I would suggest contacting the department of surgery and see if you can get a research mentor in the department. Someone who is prolific in publishing and who will mesh with you personally. Finding the right research mentor is key. If you have a long term relationship with a research mentor (who is also a clinican), they can write you a glowing LOR when it comes time to apply to residency.

Pick up a new copy of Iserson's Guide to Getting a Residency for other field specific clues. Join the surgery interest group and get involved at your school. Do well in anatomy.

 

[Marquis_Phoenix]

What are RCTs?

 

[Pinkertinkle]

False. Most basic science is conducted outside clinical departments. While many clinical departments do have R01 sponsored research the much more lucritive field of clinical trials for drug and isntrument is the real cash cow for departments. On residency interviews NEJM/JAMA >> Nature/Science

Brings in the money as in improves its NIH funding ranking, a measure by which many departments determine their prestige.
http://grants.nih.gov/grants/award/rank/medindp05.htm

On residency interviews NEJM/JAMA >> Nature/Science

I would say you're wrong there, I doubt there is a significant difference between those respected journals, except JAMA which has a pretty low impact factor compared to the other three. Nature/Science/NEJM>>JAMA.

 

[soeagerun2or]

That's highly debateable and depends a lot on the kind of school at which you're interviewing. Please cite some figures for your claims.

Logically most residencies are clinically based and thus a clinical journal would be more recognized and more often read than a basic science journal. If you're interesed in a postdoctoral research fellowship it's a whole different story. Nonetheless:

ISI Impact Factor taken from the annual Journal Citation Reports
Nature 31.198
Science 29.232
NEJM 35.046

Impact factor is the average number of citations per article for the last two years. It is used as yard stick of how important a journal is, how meaningful it's articles are, and the penetrance of it's articles in the general population.

 

[Pinkertinkle]

Logically most residencies are clinically based and thus a clinical journal would be more recognized and more often read than a basic science journal. If you're interesed in a postdoctoral research fellowship it's a whole different story. Nonetheless:

ISI Impact Factor taken from the annual Journal Citation Reports
Nature 31.198
Science 29.232
NEJM 35.046

Impact factor is the average number of citations per article for the last two years. It is used as yard stick of how important a journal is, how meaningful it's articles are, and the penetrance of it's articles in the general population.

Doctors are scientists and know that Science and Nature are highly respected journals and would respect the amount and quality of work conducted by a medical student to get such a publication, though realistically I would say very few if any medical students get first authors in journals with impact factors above 10 during medical school.

 

[MDstudent79]

I have a question related to this....

I'm an MS1 and want to do some research over the summer--possibly on a limited basis before that as time permits.

As a first-year, my specialty interests are still quite broad. I've narrowed things a bit, but I don't really know with any certainty.

I've already done clinical research in the medicine department at the local big county hospital, but I do have potential interests in some of the surgical specialties, including the general surgery derviatives and ortho.

After sending out some emails and phone calls, I got a research spot (details which will be worked out next week) with a thoracic surgeon at my university who does mostly transplants and video-assisted thoracoscopy stuff. The research will most likely be clinical research in one of those areas.

My question is how useful do you think such research would be if, for example, I decide by my 3rd/4th year that I'm more interested in ortho than general surgery options? Would it still be a valuable thing to get involved in from the CV perspective?

I find the subject interesting and figure I won't likely have an opportunity to get involved with such stuff outside of an academic setting, so I'm going to do it regardless. I'm just wondering how useful students later in their MS careers have found research that's closely but not exactly related to fields they have ultimately applied for.

Thanks!

 

[soeagerun2or]

I have a question related to this....
My question is how useful do you think such research would be if, for example, I decide by my 3rd/4th year that I'm more interested in ortho than general surgery options? Would it still be a valuable thing to get involved in from the CV perspective?

When it comes down to it, publications are publications. That's not what you asked though. If you are interested in surgery/surgical subspecialty any research in surgery looks better than research in another field (e.g. family medicine). I can't speak for certain whether general surgery research or research in a different surgical subspecialty looks better, but I know so long as it is surgery it's fine. The same goes for other fields (e.g. IM/neuro/cardio).

I want to reiterate that clinical research is looked better upon than basic science. Don’t get me wrong, I have extensive basic science research with multiple publications and love it. The fact of the matter remains that clinicians could care less. I have specifically been told by residency directors and clinical research advisors when I asked if it would be worth doing more basic science research, “When you’re in practice you don’t have time to play in a lab, you pay a Ph.D. to make cocktails for you..” So take it for what it’s worth.

 

[Pinkertinkle]

Sorry I'm going to have to continue to disagree. Clinical research, especially case reports and retrospective chart reviews, does not take much effort and is a lot of number crunching and statistics without much thought required. Basic science research demonstrates an ability to think scientifically that clinical research cannot. In addition, fewer people have basic research publications compared to clinical publications. If you want a competitive residency, especially at an academic institution (MGH, Hopkins, etc...) basic research publications help a lot more than your standard case report/retrospective review that everyone and their mom has. I have also spoken to residency directors, but that's anecdotal evidence and irrelevant to our discussion.

BTW, what year ms are you soeagerun?

 

[Bitsy3221]

I have to agree with Pinkertinkle. I applied for general surgery and only interviewed at academic institutions, and my basic science research was applauded and asked about far, far, far more often than my clinical research, much of which was published.

The caveat of this entire discussion, of course, is that it is clinically relevant basic science--gene over-expression in pancreatic cancer, MMP levels in aneurysm size, any work with cancer vaccines, etc. will probably carry you significantly farther than basic science in some protein isolation in the brush border of mice (unless it can be directly related to some clinical application). [Note: I am just using these as random examples, please do not jump all over the quality of these topics]

I think the reason basic science is preferred is because any medical student WITHOUT ANOTHER ADVANCED DEGREE (PhD, Master's) who can get involved in a basic science project and see it through to a publication demonstrates certain characteristics that are desirable in a resident. It shows you are motivated to find a lab, have the willingness to learn new techniques, are not afraid of hard work (basic science often involves a fairly structured lab schedule rather than running into medical records to do a chart review whenever you have some free time and doing this on top of your med school studies) and just a sense of dedication to work on something relatively long term.

I have found that moreso than other specialties, academic surgery LOVES research, particularly basic science. Even though they are clinicians first, virtually all academic surgeons have been involved in basic science at some point in their career (just look at the top programs, many of which REQUIRE an addition 1-2 years spent almost across the board in a basic science lab) and seek to uphold this tradition. A surgeon at my institution recently secured an RO1 NIH grant and OH MY LORD you should have seen the celebration that followed--far better than the last time we enrolled in a Phase III Clinical trial.

I have friends and mentors who are involved in residency selection processes at several schools and I have been told that a publication is a publication at this level. Getting published requires a base amount of work, and it is appreciated by people reviewing your ERAS application. I don't think that anyone would look down upon you because you "only" published in JAMA instead of Science--either would be incredibly impressive as a med student. Applying to Surg Onc? You'd be well served to have a Science article on your CV though.

 

[Bitsy3221]

I want to reiterate that clinical research is looked better upon than basic science. Don’t get me wrong, I have extensive basic science research with multiple publications and love it. The fact of the matter remains that clinicians could care less. I have specifically been told by residency directors and clinical research advisors when I asked if it would be worth doing more basic science research, “When you’re in practice you don’t have time to play in a lab, you pay a Ph.D. to make cocktails for you..” So take it for what it’s worth.

soeagerun2or, can I ask what field of medicine these residency directors/clinical research advisors were in?

 

[soeagerun2or]

soeagerun2or, can I ask what field of medicine these residency directors/clinical research advisors were in?

I've heard it from people in general surgery (chairman), internal medicine, neurology (chairman), neurosurgery (section cheif), oncology, pathology (residency director), and pulmonology. The specific quote came from a surgeon. Also, basic science advisors for my research in neuroscience as well as cancer biology have advised against bench work as a medical student.

At the end of the day I love doing research, finding new things out, and having a "biggger impact" than direct patient encounters. I love benchwork because it's so technical and I'm good at it. I'm not trying to say basic science is bad or not to do it. Just that on the interview circuit clinical science is king.

 

[Bitsy3221]

Just that on the interview circuit clinical science is king.

You and I have had very, very different medical school and interview experiences.

To the OP and interested parties: I guess you really can't go wrong either way it looks like. I'd suggest you figure out what programs you want to apply to for residency. If you want to go to the highly academic, top tier programs clinically relevant basic science may be the better option for you. If you'd feel that a smaller or community program is a better fit for you, clinical research may be better for you.

I honestly doubt that anyone will look down upon you for doing either--research will strenthen your application almost across the board. Find something you enjoy doing and have the time to do (and do well) and you will be better off for it.

 

[Pinkertinkle]

I'm not trying to say basic science is bad or not to do it. Just that on the interview circuit clinical science is king.

Just exactly how many residency interviews have you gone to?

 

[RxnMan]

A RCT is a random clinical trial, an experimental design that is both (generally) the hardest and most expensive to do, but the strongest scientifically and logically. An example would be giving Asprin to a segment of cancer patients and placebo to the rest. Blinded RCTs are where the patient doens't know that they receive the placebo (or the gold standard, as may be the case). Double-blinded tests are where neither the person giving the drug nor the recipient know what drug they get. (This reduces the possibility that the doctor gives the patient some subtle cue revealing what drug they got.)

I'll chime in with what I've heard. Our surgery chief says that a developing project is best, that is, a project you take form the bench to the patient is best. This shows repeated cycles of development and improvement. I'd also add that this is virtually impossible for a med student to do given the time it'd take.

Also:

Doing a project in your desired field is better than not, but even if you don't have a "desired field" yet, doing something is better than nothing.

Basic science, while it does (generally) provide evidence of more independent thought, is harder to get started, funded, designed, etc.

But if you don't deal with patients, then you don't have to deal with the IRB!

If you're smart:

Choose a project that can be spun into many fields: Random example, find a marker for disposition towards diabetes in blood. Many fields deal with diabetes, and (I presume) would benefit from rapid testing. You can spin the value of the project to residencies in internal medicine, genetics, preventative medicine, endocrinology, pulmonology, surgery, or EM.

Low-hanging fruit: Choose projects that are near completion, or already have funding, or are near the end of data collection. Doing stats and a write-up is much less effort, and much more likely to get your name on the by-line than data collection (which may not be finished by the time you leave!)

Choose a project that can be done in time: Like what I've written above, choose something that fits in the time you have set aside. If that means you can do two clinical projects in the time of one basic science, then maybe you should do it.

Choose a project that gets you a pub: This should go without saying, but you're in the big leagues now, and a pub should be part of the signing bonus. (though it would be nice if good pay was part of the deal...) Make sure you will end up with some line on your resume as a result of working for PI So-and-So.

Lastly, once you choose a plan, regardless of your reasons, stick to your guns and forget what everyone else says. You're doing something beyond the normal student, and that shouldn't be looked down upon by anyone.

 

[vtucci]

What are RCTs?

Randomized Control Trials.

 

[Scottish Chap]

....any good basic science research will take at least a year normally....

Much longer - especially if the student has little background in basic research.

 

[braluk]

On the same tenet as the above posts, Id like to know, would researching at your own medical school benefit more than say researching at a place in which you would like to practice your residency? Most likely, I will be going away for medical school, and Id like to come back during the summers and research at one of the well known area hospitals in New York City (or Boston- my significant other lives there), seeing that Id *like* to come back to the northeast to complete my residency. Which option would serve to my interests?

 

[braluk]

Any takers?

 

[beefballs]

the research thing is a weird one, that I can't get a total handle on-is it better to have than nothing, of course. But if you have no desire to go into an ultra competitive program is it really that important? I also disagree with JAMA/NEJM>>>than Science/NAture I am not sure that is universally the case.

to the op-you will have opportunities to do research in ugrad-use this tme to to do basic science rsearch-you have more time and will be around for a bit of time to be of use and get a pub. For specialty specific stuff-do it after your M1 year in the summer-(disclaimer-this is my advice and you will have peeps that disagree-there is no hard and fast rule except do something be productive/work hard and you should be aces)

 

[RxnMan]

On the same tenet as the above posts, Id like to know, would researching at your own medical school benefit more than say researching at a place in which you would like to practice your residency?...

I'll add my two cents in the form of questions (like Jeopardy!):

1) Do you know that you will like that particular area of the country for your residency after 4 years of med school?
2) What connection is there between the quality of a research experience at one place with a residency experience at the same institution? (e.g. Are your selection criteria the same for both?)
3) Do you think that you'll have significant time as a med student to shadow area docs?

I think moving closer to your SO for the summer is the best reason you listed. #3 is the only connection b/t residency and research at the MS1 level, and you have to work on it outside of your research obligations.

 

[RxnMan]

...But if you have no desire to go into an ultra competitive program is it really that important?...

My only argument with this reasoning, and folks will disagree, is this: are you sure that you won't change your mind? Since you're just starting your career, why limit your options? Why not generate options now and allow yourself the ability to make choices later?

 

[oldbearprofessor]

Clinical research is generally defined as research involving human beings directly and in practical terms usually requires ethical approval if being conducted on humans. It can include physiological studies on people that involve and include biochemical and hormonal testing, pharmaceutical trials including mathematical modeling of the data as well as intervention trials.

The general term of clinical research is also used to support outcomes-based research and epidemiological studies and retrospective data analysis. Most estimates are that about 30% of NIH funded primary investigator grants (R01 and similar) are clinical research projects.

Although some of you might think these are all easy projects, I challenge you to do some of them and see what you think. Of course, chart reviews are not up there with physiology studies and the like, but not all clinical research is looking up what happened to people from charts. Furthermore, some types of non-interventional research, such as outcomes research and cost-benefit analysis is very "in vogue" and much more sophisticated than you might imagine. Few are good at this and those who really do it well are very highly regarded.

Very common these days is to characterize projects as translational research which can include animal studies (especially non-rat, non-mouse studies) but also is used for a wide variety of studies that merge basic science tools with clinical outcomes.

Basic science is an equally vague term but generally refers to work that is done exclusively in a laboratory in which human or animal tissues such as cell lines may be used but it is not linked directly to findings in individual patients. Transgenic mice seem to fall here.

Everyone has different definitions of these terms and increasingly no one cares what you call it - rather it's what you do and accomplish. I suspect residency directors can figure this out. Even my research, nearly all conducted in humans and with informed consent has lots of molecular genetics involved as well as cell cultures, etc. But no one would call me a "basic scientist."

Now then, as far as prestige and where to do your research. First of all, it is not reasonable to try to decide whether publication in NEJM or Nature is better. Lots of scientists don't publish in either and have perfectly good careers.

You should try to decide what you want to get out of the research. If it is to get something on your CV that you can use to get the residency of your choice - well that's fair enough. I suggest the path of least resistance is to work as a lab hand for a while during summers. You'll learn some science, probably get your name on some papers and decide you don't want that as a career (or do...).

If you want a true academic research career, then I suggest trying a couple projects in different areas and seeing what appeals to you. It is best to end up with a significant contribution to one project than float through too many, but be ready to switch if you don't like what you start in. If it's epidemiology you like, ignore those who say it isn't real research and go do it. If its controlled trials, then get involved in one of these, even if it won't get you a publication while you're a med student. Ultimately, using this time to learn what really interests you is the most important thing.

It doesn't much matter where you do the research. It's nice to go away but not really necessary. Staying at your home institution makes going to lab meetings and staying peripherally involved in the research even while doing rotations, esp. electives, easier. Gives you more chance to interact and develop mentoring relationships over med school as well.

That may be more valuable than whatever research you actually do!

 

[braluk]

I'll add my two cents in the form of questions (like Jeopardy!):

1) Do you know that you will like that particular area of the country for your residency after 4 years of med school?
2) What connection is there between the quality of a research experience at one place with a residency experience at the same institution? (e.g. Are your selection criteria the same for both?)
3) Do you think that you'll have significant time as a med student to shadow area docs?

I think moving closer to your SO for the summer is the best reason you listed. #3 is the only connection b/t residency and research at the MS1 level, and you have to work on it outside of your research obligations.

Hey Rxn- thanks for the input

Personally I've been in the northeast most of my life, and I suppose one of my major desires to practice in the northeast and to complete my residency is to be closer to my family and to my significant other and her family as well. Ultimately I would probably like to stay in the northeast so I have no qualms about being there. As for the time committment, I probably wouldn't have much time to produce anything significant- maybe if I continue every summer to work at said institution it could produce something worth mentioning.

 

[beefballs]

My only argument with this reasoning, and folks will disagree, is this: are you sure that you won't change your mind? Since you're just starting your career, why limit your options? Why not generate options now and allow yourself the ability to make choices later?

I think people early on know whether they are going down the private practice versus academia/research routes, even if they haven't decided for sure on a specialty. If you don't know, then just doing research may help you decide btwn the two, well before you're looking for residency. Again all of my views are from my vantage point-NO desire to go into research/academics fully (maybe some on te side here and there) so I am not interested in doing the stuff that impresses these places.

Again if I was the Op I would tailor my experiences to myself, and while I don't disagree w/ Rxnmans rationale for not wanting to close any doors, I think he may be putting the cart before the horse a bit.