Utility of having medical students do research

[GoSpursGo]

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Will be interesting to see if applications for competitive specialties begin to uptick now that there is no cutoff.

Ha I have generally assumed the opposite as people will know there is less chance to stand out. But if the situation you described happens that would be awful. I guess we will see

 

[voxveritatisetlucis]

Ha I have generally assumed the opposite as people will know there is less chance to stand out. But if the situation you described happens that would be awful. I guess we will see

I have also noticed that more and more schools are opting to give full tuition or full COA (capital market outperformance is good for endowments).

It will be interesting to see whether this pushes more people in academic medicine and or lower paying specialties

 

[Ho0v-man]

Will be interesting to see if applications for competitive specialties begin to uptick now that there is no cutoff.

This is 100% what will happen when step 2 goes p/f. Lots of people in FM would love to be derm, for example.

 

[ChordaEpiphany]

I think this the root of the problem here. Why is "research" the currency we use to judge a medical student's (or resident's) dedication to a particular field?

Most of us spend half the year trying to get onto a project (on a topic often not even of our choosing) waiting to meet with attendings, having those meetings rescheduled, waiting for IRB approvals, etc. Is that really the best use of our time? What if you wanted to do something other than research - volunteer work that might be really impactful, work on a start up idea, or god forbid have other passions? Nah, that's not allowed.

Instead we take our best/brightest and have them mindlessly chart review/data collect for hours upon hours to "prove their commitment" to a certain speciality. For all that effort, as many have said already, most of these papers (if they even make it to publication) provide very little value.

The same can be said for residents applying to fellowship. Should we be encouraging them to learning clinical medicine and spend more time reading about their patients or should we have them data collect? Clearly the latter is more beneficial to society.

Reform in medical education is sorely needed and honestly I'm surprised this ruse has continued for so long. The problem imho is that we don't actually value the education part of training. Academic institutions value research because it brings extra funding/prestige and they want to groom the next generation of physicians who will achieve this for them. But what about education? Aside from anatomy lab most of our preclinical training can be done online and indeed most of it we don't even get from the medical schools (ex. UWorld, First Aid). On clinical rotations we get education out of the goodness of our residents'/attendings' hearts. As residents we're "trained" largely by our peers/immediate seniors. We see our attendings for maybe a few hours a day for brief snippets of teaching while on rounds. Where does all of our tuition money go? I would love to know.

Sigh, ok rant over. I don't know how to fix the system but until our "values" change I think we're stuck with data collecting.


Side note: If research really is your thing though, then go for it. The world would be a better place if only people really passionate about the work and the process were doing it. We all have different talents and passions. We shouldn't all be expected to fit the same mould.

Medicine is two-pronged. It exists on the national level, with the academic big wigs running the show, and it exists on a local level, with certain physicians and administrators holding an iron grip on local health networks and hospital systems. As students we see academia, but there are plenty of institutions that value the resident who spent time reading about patients more than the one collecting data. However, these less competitive residencies will more than prepare you to have influence in those local systems.

Once you enter practice the value systems will change unless you stay in academia (only ~15% of physicians). The Local Health Net you're much likely to be working with/for in the future will probably care far more about the respect you command in the community and the connections you've made than about manuscripts you've published or the academic prestige of your resume. Consider that HUP is the 17th largest hospital in Pennsylvania by Medicare volume. A few people at HUP are massively influential, and their influence on medicine as a whole outstrips basically anyone working for other big PA health systems. However, most who work there exist within just a few hospitals with a similar scope as any other local physician.

Overall you're more likely to be influential as a major player in some local health system you've never heard of until now, maybe Lehigh Valley Health Network, St. Luke's, Wellspan Health, etc... Even something as simple as owning a practice or buying into a surgery center could give you a voice on a local level that far outstrips the influence of an academic position. Look at the leadership of some of these organizations. They're not adding up your NEJM papers and handing out Executive VP positions based on that.

This is a really, really long-winded way of saying, as much as academics values research work, our healthcare system as a whole is pretty agnostic towards it. There are a lot of careers in healthcare, only a small minority require heavy research, and only a small minority of those are more influential than non-research careers.

I have also noticed that more and more schools are opting to give full tuition or full COA (capital market outperformance is good for endowments).

It will be interesting to see whether this pushes more people in academic medicine and or lower paying specialties

It won't. Barely anyone looks back and says, "wow, I'm lucky to be in this financial position, and because I could have been worse off, I'm going to give up on cardiology and pursue primary care." People almost universally accept a handout and then readjust expectations. Try telling an executive today that the tax and regulatory structures of the past 3-4 decades were massively skewed in their favor and you'd like them to accept lower pay and give up a few of their vacation homes and yachts. If you've already been given something, you stash it away as yours and keep taking.

I've done this myself. I thought I was going into a lot debt for college, then a big scholarship came through. I remember telling myself, "if I get this scholarship, I'll donate money at tax time. I'll tip my uber drivers more. I'll consider going PhD only or doing research in a highly underserved but less lucrative field." The same happened in med school to a lesser extent when I got a fellowship that came with a pay bump and a bonus (I'm MSTP). Each time I just started investing more and thinking about more expensive condos for residency or slightly nicer vacations before med school.

Rich people almost universally echo the idea that "you never feel like you have enough." It's true. It was never loans keeping people from going into primary care, it was the existence of a better option. If you want more people in primary care, the only solution is more primary care residencies and fewer fellowships.

 

[voxveritatisetlucis]

This is 100% what will happen when step 2 goes p/f. Lots of people in FM would love to be derm, for example.

How long will this take to happen in your opinion.Ie should those entering freshman expect step 2 to be scored?

 

[DarkBluMage]

I don't think you need a ton of research to match into most specialties (I think matched derm usually only have 2-3 manuscript articles published - lower at non-academic). "Higher tier" academic programs will probably want more because research is how you move up in academia, and they want to graduate alums who will help move the field forward. Even if you hate research, doing some small projects to get a few posters in 4 years isn't that much work if you work with the right faculty -- and shows you can work through a project.

Missed this somehow. Some surgical specialties were giving out information on research pubs that the average student had when applying to fields like plastics, peds surgery etc. They were in the range of 7-10 publications.

 

[Ho0v-man]

How long will this take to happen in your opinion.Ie should those entering freshman expect step 2 to be scored?

I personally doubt we’ll get to 2030 with a scored step 2 and wouldn’t be surprised to see it p/f in 2025. The scores are already really high and people barely studied for it before. People throwing everything into it like we did for step 1 will tear that test apart.

The only way it doesn’t go p/f is if program directors just decide not to use it as a stratifier and just look at other things. But with a bajillion apps, that likely won’t happen. And besides, say what you want about step scores, but this thread has good examples of everything else being fluff.

But I’m just some rando on internet and this is all ultimately speculative. Anyone’s opinion on the matter is just a guess at this point.

 

[DarkBluMage]

I think a modest amount of research in medical school is healthy. Not an extra year but one project with some dedicated research blocks across the four years seems reasonable. Having doctors that understand how research is conducted, who can maybe better distinguish good research from bad research, and are more willing to apply new research to their eventual practice seems important to me.

Research is definitely important, but it should be done by those interested in doing it to prevent garbage from being produced and to prevent undue burden on students that don’t want to pursue it during medical school or in the future. A class on research could fill the need for understanding and knowing how to evaluate research. My school has a class like that.

 

[ChordaEpiphany]

How long will this take to happen in your opinion.Ie should those entering freshman expect step 2 to be scored?

There is no way they'll do away with step 2 before seeing the effect of making step 1 P/F. I know there is a lot of pressure to subjectify admissions processes, but there are still a lot of voices in the conversation who have a strong interest in making sure they can objectively evaluate potential residents. If anything, we will probably see individual residencies claim they will not be taking step 2 scores into account before it goes officially P/F.

This is especially true for the community programs. How is a PD supposed to evaluate 500 applications from IMGs who all did clinicals in 15 different random hospitals without a single scored step exam? Speaking of, I think the true losers of the change in step scoring are probably the IMGs who won't know if it's time to hang up the hat or not until 3rd or 4th year.

Missed this somehow. Some surgical specialties were giving out information on research pubs that the average student had when applying to fields like plastics, peds surgery etc. They were in the range of 7-10 publications.

Pubs doesn't only mean manuscripts. It's relatively easy to game the system and do 15+ presentations at local conferences. Also, peds surgery would be for surgical fellows, so this would largely be people who had done a 5+2 gen surg residency.

 

[housestaffhustle]

Academic inertia. And it's easy to quantify. Number of publications x average impact factor = clean, tidy number that probably means something.

This is the prisoner's dilemma. If everyone abandoned research in unison then it would cease being a factor. But as long as some people are willing to do it to stand out then an arms race is inevitable. The same phenomenon is at play in admission to medical school.


It's an RVU world, we're just living in it.

Say you have a generic attending who works 50 hours per week, his billing brings in $1.05 million. From the department's standpoint an hour of his time is worth $400. If you pay 50K in tuition then you can afford ~125 hours of his time annually, or about 2.5 hours per week.

The real calculations are more involved, but hopefully you get the general idea

Agreed. I know there's no real solution. Just wish things could be different. The burden of needing to be productive academically while in training I think adds to burnout unnecessarily.

I can definitely see the RVU argument, but from the hospitals I've worked in attendings aren't paid extra to teach students/residents. So it's not really that students can only afford 2.5 hr of their time per week, it's that attendings don't seem to be compensated at all for the time they spend teaching. In fact, they're paid less at academic institutions. Yes, perhaps RVU quotas are lower if you do service with the housestaff, but for most I'd wager it's not enough to really move the needle. If you teach as an attending it's mostly because you want to teach, you just love the prestige of working at that academic center, or it's a required rotation. In our pre-clinical years we get lectures, but our clinical education (most of our training) seems to me to be largely based on good will. All this to say, there is limited incentive to teach beyond the bare minimum even at the top academic institutions. Again, there's no one to blame and I just wish things could be different. I suppose it's just how we've decided to structure our financial incentives despite our high tuitions and mountains of debt.

Also, just a thought - If a large part of clinical training for medical students is provided by residents/fellows (the lowest paid member of the medical team who actually does spend all day with the students), why don't they get some sort of RVU equivalent incentive?

 

[housestaffhustle]

I think what sets apart great med student researchers and those that are only doing it to check a box is how they respond. If you chart review and data collect for hours and that's all you do throughout med school, you'll show that you're committed and tough, but that doesn't show that you're going to be a great academic physician. Now if you start to lead projects and move into more senior roles, then you start to show that independent and analytical side that wins you points on the other side.

Definitely agree that taking on more senior roles/leadership positions rather than just going through the motions should distinguish you.

What gets to me is that the most "value" tends to be placed on publications regardless of the number of active leadership roles (which may not be directly tied to research) one takes. You could lead every committee/subcommittee, win every teaching award, and succeed in creating real positive change in your program, but if you don't have publications and try to apply for a competitive specialty, it won't matter. Additionally, more value is placed on certain types of research than others. QI projects, for example, can be quite effective locally at solving problems and can be very fulfilling for medical students/residents to tackle a problem they see every day, but publications for these projects are not valued as highly and are viewed as soft (in my experience).

All I'm saying is, if we're trying to select students/residents based on academic achievement, personal initiative, and leadership potential, we should do a better job of actually recognizing those things and not just one aspect of them.

Edit: Also I'm sorry, reading your post again I think I may have responded out of context. I think you were talking specifically about what would make a great K->R grant academic physician. In which case, yes, doing as much research as possible at the highest level would prove your mettle.

 

[housestaffhustle]

Medicine is two-pronged. It exists on the national level, with the academic big wigs running the show, and it exists on a local level, with certain physicians and administrators holding an iron grip on local health networks and hospital systems. As students we see academia, but there are plenty of institutions that value the resident who spent time reading about patients more than the one collecting data. However, these less competitive residencies will more than prepare you to have influence in those local systems.

Once you enter practice the value systems will change unless you stay in academia (only ~15% of physicians). The Local Health Net you're much likely to be working with/for in the future will probably care far more about the respect you command in the community and the connections you've made than about manuscripts you've published or the academic prestige of your resume. Consider that HUP is the 17th largest hospital in Pennsylvania by Medicare volume. A few people at HUP are massively influential, and their influence on medicine as a whole outstrips basically anyone working for other big PA health systems. However, most who work there exist within just a few hospitals with a similar scope as any other local physician.

Overall you're more likely to be influential as a major player in some local health system you've never heard of until now, maybe Lehigh Valley Health Network, St. Luke's, Wellspan Health, etc... Even something as simple as owning a practice or buying into a surgery center could give you a voice on a local level that far outstrips the influence of an academic position. Look at the leadership of some of these organizations. They're not adding up your NEJM papers and handing out Executive VP positions based on that.

This is a really, really long-winded way of saying, as much as academics values research work, our healthcare system as a whole is pretty agnostic towards it. There are a lot of careers in healthcare, only a small minority require heavy research, and only a small minority of those are more influential than non-research careers.

Agreed. It's a big world out there! I'll look forward to seeing what it's like on the outside. So far I've only been in large academic institutions which I know colors my opinions and limits my insights.

I'm not against research. I think we need all the brightest minds working on research that we can muster. To your point, it may be that because the healthcare system in the US as a whole is "agnostic" towards research/education that our academic/training hospitals are relatively underfunded in regards to teaching incentives. If it comes down to throughput (ex. number of discharges) vs education, throughput will win every time. Our education suffers as trainees and our autonomy suffers as attendings.

 

[imidazzle92]

Missed this somehow. Some surgical specialties were giving out information on research pubs that the average student had when applying to fields like plastics, peds surgery etc. They were in the range of 7-10 publications.

If you count posters/abstract/submitted articles, it may be that high, but I read a few papers showing that the median number of published articles for matched residents in almost all these specialties is usually under 5. I think most specialties don't really require a lot of research though, and if you're a student that wants to go into NSGY/Plastics/I6, the extra work you need to put in to get those pubs is really nothing compared to the hours you'll face in training.

 

[Med Ed]

I can definitely see the RVU argument, but from the hospitals I've worked in attendings aren't paid extra to teach students/residents. So it's not really that students can only afford 2.5 hr of their time per week, it's that attendings don't seem to be compensated at all for the time they spend teaching.

That's sort of my point. Your tuition is sucked into a system where every minute has a dollar amount attached to it, and nobody is incentivized to teach. That's why the only people who can't bill (residents) get the honor of doing so much of it.

 

[aldol16]

Are you talking at a student level? Because MD only students aren’t running clinical trials, prospective studies and high quality retrospective analyses/NEJM-level case studies that drive clinical research forward.

Why is it that you believe the studies that are driving research forward are NEJM level studies? Yes, NEJM studies are higher impact. But majority of field-specific things that we use to guide decision-making isn't in NEJM. It's in field specific journals and many, if not most, are not RCTs. Not feasible to do RCTs for everything.

MD students are not running clinical trials but you can be damn sure they can run prospective and retrospective analyses. Not at NEJM level but at a level high enough for an impactful journal in their field.

 

[Lawpy]

Why is it that you believe the studies that are driving research forward are NEJM level studies? Yes, NEJM studies are higher impact. But majority of field-specific things that we use to guide decision-making isn't in NEJM. It's in field specific journals and many, if not most, are not RCTs. Not feasible to do RCTs for everything.

MD students are not running clinical trials but you can be damn sure they can run prospective and retrospective analyses. Not at NEJM level but at a level high enough for an impactful journal in their field.

Yeah… i really doubt that. This can happen among the powerhouse students in top schools who are well connected with strong PIs but these are in the minority. NEJM was just an example but even then, i very strongly doubt students are driving top research studies into leading specialty journals unless they’re in the minority as described. These things require skills and sincere dedication, and in an environment where research is treated as a means to a residency end, it’s unlikely such studies are commonly done

 

[Ho0v-man]

Yeah… i really doubt that. This can happen among the powerhouse students in top schools who are well connected with strong PIs but these are in the minority. NEJM was just an example but even then, i very strongly doubt students are driving top research studies into leading specialty journals unless they’re in the minority as described. These things require skills and sincere dedication, and in an environment where research is treated as a means to a residency end, it’s unlikely such studies are commonly done

Agree. Most med students are 3rd author on something pointless because they made the poster in PowerPoint and printed it out. Unless your school actually allots time for this stuff, or you’re just well-connected, you ain’t doing this stuff in med school.

 

[CyrilFiggis]

Haven’t had time to read all the comments, but playing devil’s advocate here, I do believe med students should have exposure to research, but not solely as a way to be competitive for residency.

If you plan on going into a surgical specialty, research years are often required. Both you and your program should know of your abilities to do thoughtful research before starting. Additionally, I help run our residency’s journal club and it’s impressive how bad some new MDs are at interpreting publications. If these are the means by which we evolve evidence based medicine, you need to know how to tell high quality, practice changing papers from the rest.

And for those that feel like they are forced to do it instead of doing more community based care, etc., public health is a great avenue.

Finally, the side thread in all this is matching. As someone in EM, I feel like other specialties will need to start following our model of quantitative peer evaluations. I matched before P/F and had a low Step 1. But having to do aways and show that my step score did not reflect my clinical abilities was the thing that allowed me to interview and match at my top program.

 

[CrazyHorseLady]

As I often do, I like to speculate on the state of medical education and how I think things should be done. Now fast forward to 2022, Step 1 is P/F. A lot of medical students are turning to research to differentiate themselves for residency whereas before the focus was classes, Step 1. I just fear there's going to be a lot of BS research pumped out. At the end of the day, the objective is to learn medicine, not find a way to wriggle onto a project where you collect a few variables in an Excel sheet.

Note this isn't targeted to medical students going through this. Ya'll do what you need to do. I'm just questioning the utility of focusing on research in a more general sense. There need to be more ways for one to demonstrate their aptitude for a field early on. Maybe there can be a standardized aptitude test for each specialty.

This is definitely something I have thought about as a current MS3. I did take the last scored Step, but I have been asked many times by school coordinators and other students why I haven’t done research. I hate that its an unsaid “requirement” at this point. Since I do not enjoy being in a lab nor do I want to do a specialty that’s research focused I feel I have better uses of my time than sacrificing rats. I have also tried to do research that was more clinical based but was rejected for not having EMR access as a second year so nothing I can do about that. I am sure I will be asked about it in interviews and I have not thought of a good counter response yet. But I still have about 6 months to think of one lol.

 

[Putkernerinthehall]

Agree. Most med students are 3rd author on something pointless because they made the poster in PowerPoint and printed it out. Unless your school actually allots time for this stuff, or you’re just well-connected, you ain’t doing this stuff in med school.

Schools are continuing to add research elements (dedicated time / blocks) to their curriculums.

Yale requires a research thesis / dissertation as part of their curriculum. Virginia Tech has a 3.5 year program with built-in research blocks and recruits heavily for prior research experience. These schools and others have students doing a lot more than you give them credit for.

And it should be encouraged. Having doctors that understand how research is conducted, who can maybe better distinguish good research from bad research, and are more willing to apply new research to their eventual practice is important.

 

[i-doctor]

Just put all the students into a Hunger Games battle and the winners get their residencies of choice. Mercifully quick and easy, as opposed to death-by-1000-cuts system we have now.

 

[PhD_to_DO]

Just put all the students into a Hunger Games battle and the winners get their residencies of choice. Mercifully quick and easy, as opposed to death-by-1000-cuts system we have now.

I’m going into my second year at a newish DO program that has a small but growing research footprint. I’m seeing many of my classmates engage in Hunger Game-like battles to get on the few projects that we have at the school. I was fortunate to maintain my prior research affiliations from my PhD studies so I’m not competing with classmates for opportunities to be 3rd author on some publication or to present a poster at some obscure local conference. Sad thing is that many of my classmates don’t care about research; its a knee jerk reaction to our advisors telling us, “You better do research if you want to match!”

 

[MDMechEngr]

Fortunate to be at a school/program that has allowed me to first author a project/paper. Presenting it at a national confernce also. Had to turn down an ortho project couple months into med school because not shooting for ortho and had two other projects going already. shooting for something very competitive, but not ortho.

 

[Lawpy]

Schools are continuing to add research elements (dedicated time / blocks) to their curriculums.

Yale requires a research thesis / dissertation as part of their curriculum. Virginia Tech has a 3.5 year program with built-in research blocks and recruits heavily for prior research experience. These schools and others have students doing a lot more than you give them credit for.

And it should be encouraged. Having doctors that understand how research is conducted, who can maybe better distinguish good research from bad research, and are more willing to apply new research to their eventual practice is important.

You can understand basic research methods without being forced to produce garbage papers and studies. It’s not that hard. A research course is more than enough. Also, Yale is a top school that attracts and selects for high caliber students, so the results aren’t surprising. I don’t know what VTech is doing exactly to comment on that.

 

[Lawpy]

Haven’t had time to read all the comments, but playing devil’s advocate here, I do believe med students should have exposure to research, but not solely as a way to be competitive for residency.

If you plan on going into a surgical specialty, research years are often required. Both you and your program should know of your abilities to do thoughtful research before starting. Additionally, I help run our residency’s journal club and it’s impressive how bad some new MDs are at interpreting publications. If these are the means by which we evolve evidence based medicine, you need to know how to tell high quality, practice changing papers from the rest.

And for those that feel like they are forced to do it instead of doing more community based care, etc., public health is a great avenue.

Finally, the side thread in all this is matching. As someone in EM, I feel like other specialties will need to start following our model of quantitative peer evaluations. I matched before P/F and had a low Step 1. But having to do aways and show that my step score did not reflect my clinical abilities was the thing that allowed me to interview and match at my top program.

Understanding and interpreting research studies isn’t difficult, and it isn’t something so complex that couldn’t be covered by a research course and boards prep materials.

 

[Dr G Oogle]

Understanding and interpreting research studies isn’t difficult, and it isn’t something so complex that couldn’t be covered by a research course and boards prep materials.

There is already this occurring in med school. Sections on biostatistics both in schools and on boards (thus on board prep). It is not enough to help people really understand stats enough to understand good from bad quality studies. But I don’t think that’s super critical either. As posters above noted the majority of docs are not deeply involved in research, and I don’t think you need a very good knowledge of stats and research to be able to understand what you need to adopt in your practice that’s up to guidelines, those things make it into the zeitgeist always.

However, people that want to do peer review, research of any sort, serve on editorial boards, write guidelines, etc DO need much more than med schools/residency currently offers en masse. Instead of forcing every med stud to do research, we should focus those resources on people who actually want to do that and maybe beef up the existing curriculum for everyone else. There should be other ways for other people not interested in research to demonstrate their abilities, could be business classes, advocacy, community engagement. If I was reviewing 2 apps that were equal and one had 4 pubs of middling quality and the other had no pubs but spent 2 years in a community health clinic and maybe developed some initiatives there (both requirement relatively the same amount of effort) I’d take the person in the community clinic.

 

[Dr Meow]

I still feel that, in the end, it’s often about who really wants it more, and how much extra they are willing to do to make it happen.

Access to research opportunities is a finite resource and it is also circumstantial.
At new DO schools, it's much harder to get bench research no matter how much you want it. But You could write case reports if you got a cadaver lab. So that's something.

Also, there's a bit of luck involved. I know people that put in the time and work but in the end got screwed by the PI who refused to include their name on the paper at all. And you may end up on the wrong project or team and not publish at all. Or you have a PI that decides to scrap your project.

 

[Putkernerinthehall]

You can understand basic research methods without being forced to produce garbage papers and studies. It’s not that hard. A research course is more than enough. Also, Yale is a top school that attracts and selects for high caliber students, so the results aren’t surprising. I don’t know what VTech is doing exactly to comment on that.

Virginia Tech recruits heavily for prior research exposure / experience. It has a required research course during M1 (which I believe extends into part of M2). In addition, students work with a mentor / PI to develop a project that then spans the remaining 3 years of their education.

There are built-in research blocks and various steps along the way for presentations and writing. The requirement is to produce meaningful research of publishable quality by end of M4. The school's small class size (49 students) and presence of a growing research institute (Fralin), affiliated with and immediately adjacent to the medical school, provides a lot of opportunities for basic science / bench and clinically-oriented projects with senior researchers.

For this school, you probably would not apply (nor get accepted) without a strong interest in research and some undergraduate research experience. I'm not saying research in medical schools should be required, but a lot of schools are doing it and some are doing it well. And where it's done well, I think it can be advantageous to students.

 

[Redpancreas]

You can understand basic research methods without being forced to produce garbage papers and studies. It’s not that hard. A research course is more than enough. Also, Yale is a top school that attracts and selects for high caliber students, so the results aren’t surprising. I don’t know what VTech is doing exactly to comment on that.

They were P/F with a decent match list last time I heard.

 

[Redpancreas]

Virginia Tech recruits heavily for prior research exposure / experience. It has a required research course during M1 (which I believe extends into part of M2). In addition, students work with a mentor / PI to develop a project that then spans the remaining 3 years of their education.

There are built-in research blocks and various steps along the way for presentations and writing. The requirement to is produce meaningful research of publishable quality by end of M4. The school's small class size (49 students) and presence of a growing research institute (Fralin), affiliated with and immediately adjacent to the medical school, provides a lot of opportunities for basic science / bench and clinically-oriented projects with senior researchers.

For this school, you probably would not apply (nor get accepted) without a strong interest in research and some undergraduate research experience. I'm not saying research in medical schools should be required, but a lot of schools are doing it and some are doing it well. And where it's done well, I think it can be advantageous to students.

This is very interesting information id they truly recruit for research experience. I'm sure VTech advertises this well, but the problem is that every school writes research in their mission statement. I bet you only come to hear of VTs research commitment if you're there for an interview. Low class size is also usually a plus IMO.

 

[Lawpy]

Virginia Tech recruits heavily for prior research exposure / experience. It has a required research course during M1 (which I believe extends into part of M2). In addition, students work with a mentor / PI to develop a project that then spans the remaining 3 years of their education.

There are built-in research blocks and various steps along the way for presentations and writing. The requirement to is produce meaningful research of publishable quality by end of M4. The school's small class size (49 students) and presence of a growing research institute (Fralin), affiliated with and immediately adjacent to the medical school, provides a lot of opportunities for basic science / bench and clinically-oriented projects with senior researchers.

For this school, you probably would not apply (nor get accepted) without a strong interest in research and some undergraduate research experience. I'm not saying research in medical schools should be required, but a lot of schools are doing it and some are doing it well. And where it's done well, I think it can be advantageous to students.

I’m really curious to know the research output from that school if it’s going to act like a research powerhouse

 

[Putkernerinthehall]

I’m really curious to know the research output from that school if it’s going to act like a research powerhouse

I'm not aware of their output relative to other schools. It's a pretty new school (~15 years) but is partnered with a large health system (Carilion) and the Fralin Biomedical Research Institute. I read that Fralin has about $150 million in active grants and contracts, mostly from NIH. Research facilities are housed in about 300,000 square feet with 35-40 PI's and 400 or so employees. Sounds like it is growing.

I was just making the point that there are some schools putting increased emphasis on research for those medical students who value it.

 

[Lawpy]

I'm not aware of their output relative to other schools. It's a pretty new school (~15 years) but is partnered with a large health system (Carilion) and the Fralin Biomedical Research Institute. I read that Fralin has about $150 million in active grants and contracts, mostly from NIH. Research facilities are housed in about 300,000 square feet with 35-40 PI's and 400 or so employees. Sounds like it is growing.

I was just making the point that there are some schools putting increased emphasis on research for those medical students who value it.

Oh I understand. I was just wondering whether these schools that are going so heavy on research expectations actually are producing the desired outcomes. If they’re actually pushing their students and helping them in any and every capacity to publish good papers, they deserve the fullest praise and I have zero objections. I realize I sound really jaded in this thread but it just sucks seeing so much garbage being pumped out at a lot of schools just to check the research box that schools who are truly genuine about pushing research and students actually publishing good research with school support are a rarity in themselves.

 

[mvenus929]

I think this the root of the problem here. Why is "research" the currency we use to judge a medical student's (or resident's) dedication to a particular field?

Most of us spend half the year trying to get onto a project (on a topic often not even of our choosing) waiting to meet with attendings, having those meetings rescheduled, waiting for IRB approvals, etc. Is that really the best use of our time? What if you wanted to do something other than research - volunteer work that might be really impactful, work on a start up idea, or god forbid have other passions? Nah, that's not allowed.

Instead we take our best/brightest and have them mindlessly chart review/data collect for hours upon hours to "prove their commitment" to a certain speciality. For all that effort, as many have said already, most of these papers (if they even make it to publication) provide very little value.

The same can be said for residents applying to fellowship. Should we be encouraging them to learning clinical medicine and spend more time reading about their patients or should we have them data collect? Clearly the latter is more beneficial to society.

Reform in medical education is sorely needed and honestly I'm surprised this ruse has continued for so long. The problem imho is that we don't actually value the education part of training. Academic institutions value research because it brings extra funding/prestige and they want to groom the next generation of physicians who will achieve this for them. But what about education? Aside from anatomy lab most of our preclinical training can be done online and indeed most of it we don't even get from the medical schools (ex. UWorld, First Aid). On clinical rotations we get education out of the goodness of our residents'/attendings' hearts. As residents we're "trained" largely by our peers/immediate seniors. We see our attendings for maybe a few hours a day for brief snippets of teaching while on rounds. Where does all of our tuition money go? I would love to know.

Sigh, ok rant over. I don't know how to fix the system but until our "values" change I think we're stuck with data collecting.


Side note: If research really is your thing though, then go for it. The world would be a better place if only people really passionate about the work and the process were doing it. We all have different talents and passions. We shouldn't all be expected to fit the same mould.

So, I don't think research should be the be-all, end-all of residency (or fellowship) applications, because it is hard to get good research done in a short period of time. I absolutely agree that other things, like clinical excellence, efforts at improving patient care (QI projects), improving the student experience, teaching, etc, should all be considered as part of the application process. I'd like to think we'll get there eventually.

I disagree that research experience isn't useful or doesn't provide additional learning. I did a case report as a med student and learned a ton reading about the condition and trying to understand what was already in the literature. I also did a complete prospective, observational study during my residency training and learned a lot about what I was studying, which has been helpful for my current job (from conception to publication, this project took me about 4 years). My projects during fellowship were all targeted at trying to answer new questions that weren't well described in the literature already. The problem is that med students have such a breadth of information that they need to know (for clerkships and steps and whatnot) that it's really hard to get as much depth as one needs to do a good study. I have a couple of med students and residents working on projects with me right now--the med students don't even understand the basics of what we're studying despite me encouraging them to read more about (and providing the literature to do so). The resident is generally better, but they also want to be in my subspecialty, so enjoy reading more about it.

Understanding and interpreting research studies isn’t difficult, and it isn’t something so complex that couldn’t be covered by a research course and boards prep materials.

I mean, it is taught (both in med school and by boards prep at all levels up to specialty boards), but the teaching I got in medical school was very different than the teaching I got as part of my master's degree, and suddenly it was much easier to read articles and critically appraise them. I've also participated in a lot of journal clubs, and it very much feels like the blind leading the blind, because the person presenting the article doesn't fully understand the stats (in particular), so can't make an argument about whether or not the protocol and analysis were appropriate for the question that was being asked, and none of the attending leaders called them out on it. It's one thing that really drives me crazy about our division's journal club that I'm trying to find a way of improving--but even the sessions I got from my attendings on stats didn't really stick and help clarify it.

Basically, I don't think most people teach stats very well because they see it as a very dry subject.

I'm not aware of their output relative to other schools. It's a pretty new school (~15 years) but is partnered with a large health system (Carilion) and the Fralin Biomedical Research Institute.

Reading this makes me feel old. The first graduating class from VT graduated the same year I did--which I remember because I went to UVA and we had a lot of concerns about whether or not we were going to be permitted to continue rotating at Carilion when they got to clerkships (we were) and I ended up doing some of my rotations with them. I started med school 12 years ago 🙂

 

[Lawpy]

There is already this occurring in med school. Sections on biostatistics both in schools and on boards (thus on board prep). It is not enough to help people really understand stats enough to understand good from bad quality studies. But I don’t think that’s super critical either. As posters above noted the majority of docs are not deeply involved in research, and I don’t think you need a very good knowledge of stats and research to be able to understand what you need to adopt in your practice that’s up to guidelines, those things make it into the zeitgeist always.

However, people that want to do peer review, research of any sort, serve on editorial boards, write guidelines, etc DO need much more than med schools/residency currently offers en masse. Instead of forcing every med stud to do research, we should focus those resources on people who actually want to do that and maybe beef up the existing curriculum for everyone else. There should be other ways for other people not interested in research to demonstrate their abilities, could be business classes, advocacy, community engagement. If I was reviewing 2 apps that were equal and one had 4 pubs of middling quality and the other had no pubs but spent 2 years in a community health clinic and maybe developed some initiatives there (both requirement relatively the same amount of effort) I’d take the person in the community clinic.

I mean, it is taught (both in med school and by boards prep at all levels up to specialty boards), but the teaching I got in medical school was very different than the teaching I got as part of my master's degree, and suddenly it was much easier to read articles and critically appraise them. I've also participated in a lot of journal clubs, and it very much feels like the blind leading the blind, because the person presenting the article doesn't fully understand the stats (in particular), so can't make an argument about whether or not the protocol and analysis were appropriate for the question that was being asked, and none of the attending leaders called them out on it. It's one thing that really drives me crazy about our division's journal club that I'm trying to find a way of improving--but even the sessions I got from my attendings on stats didn't really stick and help clarify it.

Basically, I don't think most people teach stats very well because they see it as a very dry subject.

I meant something more advanced than a med school stats course, which I agree isn’t enough. I’m thinking an advanced research elective taught by statisticians.

I mean I even found this video far more informative and crucial in fact:

 

[aldol16]

Yeah… i really doubt that. This can happen among the powerhouse students in top schools who are well connected with strong PIs but these are in the minority. NEJM was just an example but even then, i very strongly doubt students are driving top research studies into leading specialty journals unless they’re in the minority as described. These things require skills and sincere dedication, and in an environment where research is treated as a means to a residency end, it’s unlikely such studies are commonly done

You do realize that the top journals account for a small minority of the actual research right? The rest of the research is still impactful if not in a top journal. Putting that aside, yes, it takes motivation and ability to put out good research. I would argue that most medical students are capable of learning what is necessary to generate a prospective or retrospective cohort study. Clinical studies don't take as long as basic science and often can be done at your own pace (especially for retrospective). Takes motivation and some time but most medical students are capable of it. Whether they want to is another story.

 

[Lawpy]

You do realize that the top journals account for a small minority of the actual research right? The rest of the research is still impactful if not in a top journal. Putting that aside, yes, it takes motivation and ability to put out good research. I would argue that most medical students are capable of learning what is necessary to generate a prospective or retrospective cohort study. Clinical studies don't take as long as basic science and often can be done at your own pace (especially for retrospective). Takes motivation and some time but most medical students are capable of it. Whether they want to is another story.

Even medium to low-medium impact journals are uncommon for med students. And the bolded is basically my point. I’m directly discussing the actual quality of the works produced by med students, and honestly, most of that work is completely garbage that’s done solely with the goal of matching somewhere in a field of interest. MD/PhD students are fundamentally much more committed and driven to do good research and publish well because basic science itself is a hard field with a lot of failures and disappointments (and these students are selected for before entering school). The work is reflected in the output. Med students can have the potential do good research but this is not seen in the resulting output, except in rare circumstances of students being well connected with strong research mentors and driven to publish well.

As outlined earlier, the ideal situation is to invest resources only in those students who want to do good research and let everyone else do what they want.

 

[effectedtag]

Virginia Tech recruits heavily for prior research exposure / experience. It has a required research course during M1 (which I believe extends into part of M2). In addition, students work with a mentor / PI to develop a project that then spans the remaining 3 years of their education.

There are built-in research blocks and various steps along the way for presentations and writing. The requirement is to produce meaningful research of publishable quality by end of M4. The school's small class size (49 students) and presence of a growing research institute (Fralin), affiliated with and immediately adjacent to the medical school, provides a lot of opportunities for basic science / bench and clinically-oriented projects with senior researchers.

For this school, you probably would not apply (nor get accepted) without a strong interest in research and some undergraduate research experience. I'm not saying research in medical schools should be required, but a lot of schools are doing it and some are doing it well. And where it's done well, I think it can be advantageous to students.

I am curious on what the thoughts are on VTC? I am still deciding between VTC and IU. I love the integrated research, but I noticed since it is a very in depth project most students did not have high research output. Unfortunately, it seems like for residency programs it is quantity over quality of research. Can PDs discern that you did a very in depth project or would a bunch of easier clinical research still look better? I noticed this for students who matched derm, plastics etc, but they matched at the home program, making me believe they made great connections but would not have had the research output necessary to match at other places. To me that is concerning since VTC is missing a lot of home programs.

 

[Dr Meow]

Correct me if i'm wrong but it seems the criteria to get into med school and getting into residency follow different criterias
Getting into med school Volunteer >>>> Research.
Getting into residency Research >>>> Volunteering
That seems like an inconsistency.
I have bare minimum shadowing/volunteering but I spent 7 years on research with all publications ranging from 5 - 25 Impact factor working ~13-16 hours a day.
No MD/established DO school would consider me without the volunteering component.

When people gets into med school, somehow....none of that volunteering stuff matters nearly as much anymore....basically not at all.
and it's research research research.
But why not accept based on research in the first place? isn't someone "better" suited for residency also "better" for medical school?
If the answer is that "they do not expect any premed to have research", then having research should be an extra extra bonus rather than making research a minor criteria weaker than volunteering/shadowing which is basically standing around, maybe some history collection.

 

[aldol16]

Even medium to low-medium impact journals are uncommon for med students. And the bolded is basically my point. I’m directly discussing the actual quality of the works produced by med students, and honestly, most of that work is completely garbage that’s done solely with the goal of matching somewhere in a field of interest. MD/PhD students are fundamentally much more committed and driven to do good research and publish well because basic science itself is a hard field with a lot of failures and disappointments (and these students are selected for before entering school). The work is reflected in the output. Med students can have the potential do good research but this is not seen in the resulting output, except in rare circumstances of students being well connected with strong research mentors and driven to publish well.

Comparing basic science to clinical science is not a valid comparison. Cannot directly compare the quality of the studies. Setting that aside for a moment, if you look at the basic science papers put out by MD/PhD students and the clinical papers put out by MD students, you'll find that the impact of the journals are going to be similar. MD/PhD students aren't publishing Nature or Science papers left and right. As someone with extensive experience in both basic and clinical research, I would say that you're simply wrong. But keep on believing what you believe.

 

[Lawpy]

Comparing basic science to clinical science is not a valid comparison. Cannot directly compare the quality of the studies. Setting that aside for a moment, if you look at the basic science papers put out by MD/PhD students and the clinical papers put out by MD students, you'll find that the impact of the journals are going to be similar. MD/PhD students aren't publishing Nature or Science papers left and right. As someone with extensive experience in both basic and clinical research, I would say that you're simply wrong. But keep on believing what you believe.

It’s not a belief, and my comments are exactly based on the observations of research outputs from MD/PhD and MD students. MD/PhD students have regularly published in fairly impactful journals with decently large impact factors. The nature of the papers themselves is systematic and thorough. MD student research is usually found sparsely in low impact journals or as case reports, not usually in bigger journals with detailed, thorough analyses. I’m also speaking from experience in both basic and clinical research but clearly you have had the better fortune of associating with MD students who produce good clinical research.

 

[Dr Meow]

Anecdote time!

I once had a colleague Medical student that nonchalantly fakes data.
He knew exactly what he was doing. Purposely misusing cell counters to count dead cells as "live". Purposely misusing other machinery to select exactly the population that fit his views, even though it was again gated on again...."dead" cells and gave him the phenotype he wanted that live cells didn't have... and he counted it as "live".
And led the PI for X years to gain enough favors to get a greater letter. At one point, the PI shaking his hand and congratulating him for such good data. The PI was too happy with the fake data to want to hear anything otherwise.
I told the student, you're selecting only the dead cells and marking it as live! And he said "What would you have me do? Don't get me in trouble" and walks off.
I was watching in disgust after having been scolded by this PI for reporting the faker on his data.

This guy is now in a top fellowship. Looks like his fake it till you make it scheme paid off.
This was very early on. I just couldn't believe how gullible some people are.

 

[housestaffhustle]

Correct me if i'm wrong but it seems the criteria to get into med school and getting into residency follow different criterias
Getting into med school Volunteer >>>> Research.
Getting into residency Research >>>> Volunteering
That seems like an inconsistency.
I have bare minimum shadowing/volunteering but I spent 7 years on research with all publications ranging from 5 - 25 Impact factor working ~13-16 hours a day.
No MD/established DO school would consider me without the volunteering component.

When people gets into med school, somehow....none of that volunteering stuff matters nearly as much anymore....basically not at all.
and it's research research research.
But why not accept based on research in the first place? isn't someone "better" suited for residency also "better" for medical school?
If the answer is that "they do not expect any premed to have research", then having research should be an extra extra bonus rather than making research a minor criteria weaker than volunteering/shadowing which is basically standing around, maybe some history collection.

I think applying to med school with some research background would be highly valued, but you have to have some sort of clinical experience (ie. shadowing/volunteering) to show that you know what you're getting yourself into.

That being said, I totally agree with you. The inconsistencies abound.

Also to a certain extent I feel like volunteering = research, unless you're getting a stipend for research of course. As residents we're essentially volunteering (ie. doing work without immediate expectation of a tangible benefit) our time to do the grunt work and serve the research interests of our mentors. Though I'm sure some rare exceptions are able to fully direct their own research projects in residency.

Warning: Tangent coming...

The whole pathway from undergrad -> med school -> residency teaches us that not being compensated for our time is the norm, that it's ok our time is not our own because we have "a higher calling." It's this culture/goodwill that hospitals take advantage of.
"This clinic patient came an hour late, but are you really going to turn them away?"
"You can take a few extra admission just to help out can't you?"
"Keep track of your work hours, but if you ever find you're going over the restrictions come talk to us first so we can work it out."
"You want to take some time off to see your PMD for the first time in 3 years because you just can't seem to find an appointment that fits your schedule? Hmmm but you're really needed here. Think of the other people who would have to cover for you."

Meanwhile, any other unionized group (not to point fingers) in the hospital...
"You want me to stay for an extra hour? Pay me overtime."
"You want me to work over a holiday? Pay me overtime."
"You want me to work for 27 hours straight? That doesn't sound right. Ooo but on average I'm not really working that many hours? Nah."
"I don't get a lunch break? Hell no."
"You want me to do what? That's not in my job description, sorry."
"I'm not really happy with my experience here but I can't leave this job because I'm legally bound to stay and even if I did manage to leave I'd have a really hard time continuing my career and good luck paying off my student loans if I did? That definitely doesn't sound right."

🤔


Even as an attending they'll wring every bit of productivity out of you that you can muster. Sorry, #jaded

 

[Putkernerinthehall]

I think applying to med school with some research background would be highly valued, but you have to have some sort of clinical experience (ie. shadowing/volunteering) to show that you know what you're getting yourself into.

That being said, I totally agree with you. The inconsistencies abound.

Also to a certain extent I feel like volunteering = research, unless you're getting a stipend for research of course. As residents we're essentially volunteering (ie. doing work without immediate expectation of a tangible benefit) our time to do the grunt work and serve the research interests of our mentors. Though I'm sure some rare exceptions are able to fully direct their own research projects in residency.

Warning: Tangent coming...

The whole pathway from undergrad -> med school -> residency teaches us that not being compensated for our time is the norm, that it's ok our time is not our own because we have "a higher calling." It's this culture/goodwill that hospitals take advantage of.
"This clinic patient came an hour late, but are you really going to turn them away?"
"You can take a few extra admission just to help out can't you?"
"Keep track of your work hours, but if you ever find you're going over the restrictions come talk to us first so we can work it out."
"You want to take some time off to see your PMD for the first time in 3 years because you just can't seem to find an appointment that fits your schedule? Hmmm but you're really needed here. Think of the other people who would have to cover for you."

Meanwhile, any other unionized group (not to point fingers) in the hospital...
"You want me to stay for an extra hour? Pay me overtime."
"You want me to work over a holiday? Pay me overtime."
"You want me to work for 27 hours straight? That doesn't sound right. Ooo but on average I'm not really working that many hours? Nah."
"I don't get a lunch break? Hell no."
"You want me to do what? That's not in my job description, sorry."
"I'm not really happy with my experience here but I can't leave this job because I'm legally bound to stay and even if I did manage to leave I'd have a really hard time continuing my career and good luck paying off my student loans if I did? That definitely doesn't sound right."

🤔


Even as an attending they'll wring every bit of productivity out of you that you can muster. Sorry, #jaded

Why would you work that hard ? Why not push back some ? Why don't doctors collectively push back on hospital / employer demands ?

 

[Dr Meow]

Why would you work that hard ? Why not push back some ? Why don't doctors collectively push back on hospital / employer demands ?

I think it's because the hospitals have too much leverage against residents. Afterall, if they fire you from residency, all the work you put in for your ENTIRE LIFE essentially is wasted. Being fired from residency is like having a gun held to your head. If you're fired, you'll end up with debt that you may never recover from. That's basically a death sentence, and at best, a living hell. I can't imagine EVER recovering from 300K debt at my old job making 55K. In terms of what goes into savings, barely anything.

On the other hand, NP's, PAs have ALL THE leverage to themselves..."Oh you want to fire me? GO AHEAD! I can find another job". because they don't have the fear of being fired from residency! Therefore, it's easy for them to unionize when individually, they all have so much flexibility.

On top of all that, they have the greatest thing working for them: Dunn kruger. Misplaced confidence analogous to a cult level of confidence. Meanwhile, med students and residents have been beaten down since the very beginning. We have the opposite of dun kruger, we have imposter syndrome. How can we unionize with such a mentality?

The only docs in the position of fixing this **** are the attendings. And the hospitals have set things up in such a way that the attendings are replaceable due to mid level encroachment. So year after year, PC doc leverage falls. The only ones left are the specialists, who are such a minor population and they're making good enough money that they're not frustrated enough to help the movement. Where I live, there are no docs essentially. To see a real doc requires a 3 week appointment. The rest of the time I can only manage to see these clueless NP's.

 

[Putkernerinthehall]

I think it's because the hospitals have too much leverage against residents. Afterall, if they fire you from residency, all the work you put in for your ENTIRE LIFE essentially is wasted. Being fired from residency is like having a gun held to your head. If you're fired, you'll end up with debt that you may never recover from. That's basically a death sentence, and at best, a living hell. I can't imagine EVER recovering from 300K debt at my old job making 55K. In terms of what goes into savings, barely anything.

On the other hand, NP's, PAs have ALL THE leverage to themselves..."Oh you want to fire me? GO AHEAD! I can find another job". because they don't have the fear of being fired from residency! Therefore, it's easy for them to unionize when individually, they all have so much flexibility.

On top of all that, they have the greatest thing working for them: Dunn kruger. Misplaced confidence analogous to a cult level of confidence. Meanwhile, med students and residents have been beaten down since the very beginning. We have the opposite of dun kruger, we have imposter syndrome. How can we unionize with such a mentality?

The only docs in the position of fixing this **** are the attendings. And the hospitals have set things up in such a way that the attendings are replaceable due to mid level encroachment. So year after year, PC doc leverage falls. The only ones left are the specialists, who are such a minor population and they're making good enough money that they're not frustrated enough to help the movement. Where I live, there are no docs essentially. To see a real doc requires a 3 week appointment. The rest of the time I can only manage to see these clueless NP's.

Patients need to demand to see a doctor. When they want to schedule me with a mid-level, I always ask "oh, how much less does that cost" and I get dead silence for a few seconds...."uh, uh, it costs the same." And I say, "ok, then I'll see an MD." Patient behavior is key here.

I agree with you regarding residents. I'm really thinking about the attending docs. The attending docs need to collectively push back. After all, the doctors are the brains of the entire operation ---- they need to start taking charge of their profession. If both docs and patients push back, progress can be made.

While I'm at it here, where is the AMA in all of this ? Don't the docs elect or somehow have a say in the AMA make-up and their agenda ? Why don't the docs pressure at the AMA level, lobbying, etc. ? It sounds to me like the docs either cannot figure out how to collectively attack this mid-level thing or enough of them don't see it as a big enough problem to take action.

I'm way off the original topic. Sorry.

 

[Lawpy]

I think it's because the hospitals have too much leverage against residents. Afterall, if they fire you from residency, all the work you put in for your ENTIRE LIFE essentially is wasted. Being fired from residency is like having a gun held to your head. If you're fired, you'll end up with debt that you may never recover from. That's basically a death sentence, and at best, a living hell. I can't imagine EVER recovering from 300K debt at my old job making 55K. In terms of what goes into savings, barely anything.

On the other hand, NP's, PAs have ALL THE leverage to themselves..."Oh you want to fire me? GO AHEAD! I can find another job". because they don't have the fear of being fired from residency! Therefore, it's easy for them to unionize when individually, they all have so much flexibility.

On top of all that, they have the greatest thing working for them: Dunn kruger. Misplaced confidence analogous to a cult level of confidence. Meanwhile, med students and residents have been beaten down since the very beginning. We have the opposite of dun kruger, we have imposter syndrome. How can we unionize with such a mentality?

The only docs in the position of fixing this **** are the attendings. And the hospitals have set things up in such a way that the attendings are replaceable due to mid level encroachment. So year after year, PC doc leverage falls. The only ones left are the specialists, who are such a minor population and they're making good enough money that they're not frustrated enough to help the movement. Where I live, there are no docs essentially. To see a real doc requires a 3 week appointment. The rest of the time I can only manage to see these clueless NP's.

Some programs have resident unions

 

[SurfingDoctor]

It’s pretty clear where residency applications are heading…

 

[ChordaEpiphany]

Correct me if i'm wrong but it seems the criteria to get into med school and getting into residency follow different criterias
Getting into med school Volunteer >>>> Research.
Getting into residency Research >>>> Volunteering
That seems like an inconsistency.
I have bare minimum shadowing/volunteering but I spent 7 years on research with all publications ranging from 5 - 25 Impact factor working ~13-16 hours a day.
No MD/established DO school would consider me without the volunteering component.

When people gets into med school, somehow....none of that volunteering stuff matters nearly as much anymore....basically not at all.
and it's research research research.
But why not accept based on research in the first place? isn't someone "better" suited for residency also "better" for medical school?
If the answer is that "they do not expect any premed to have research", then having research should be an extra extra bonus rather than making research a minor criteria weaker than volunteering/shadowing which is basically standing around, maybe some history collection.

It depends on how you shape your application and what you are applying for. No one cared at all about my clinical/shadowing/volunteer experience for MSTP. Only research mattered. To a certain extent, it was actually a poor way to do it because first author papers don't get published in time (my own FA paper came out my first year of med school), and middle author papers for undergrads are almost always luck + favors. Get on a project close to publishing with a grad student that enjoys mentoring and you'll wind up on the paper. As a grad student now, it's so easy to see how little the student's own abilities factor into actually getting on a pub.

Comparing basic science to clinical science is not a valid comparison. Cannot directly compare the quality of the studies. Setting that aside for a moment, if you look at the basic science papers put out by MD/PhD students and the clinical papers put out by MD students, you'll find that the impact of the journals are going to be similar. MD/PhD students aren't publishing Nature or Science papers left and right. As someone with extensive experience in both basic and clinical research, I would say that you're simply wrong. But keep on believing what you believe.

IF =/= quality or even impact. Impact factor is just citations. When garbage cites garbage, the impact factor goes up. While clinicians publish as much (if not more) than basic scientists, basic scientists are full time researchers with teams of 5-30 people working on a project for years. Most publishing clinicians see patients with at least 80% effort, and they do substantially less work on substantially less rigorous publications. If the standards for publishing in clinical research were as high as basic science, very little would get published.

As an example, I have published in JNCCN and in Cancer Research. They have similar IFs (11.9 vs. 12.7). The Cancer Research paper was a rigorous study completed over 3 years with a large team (~15 authors). It had 7 figures (6-12 panels each), 12 supplemental figures, and 4 in vivo studies. The revision process took > 1 year as reviewers picked apart every claim and demanded more experiments. The JNCCN paper was a culmination of 6 months of part-time work on a retrospective study between about 6 people, most of whom were added as authors for political reasons. It had 4 tables (all just listing objective patient information), a flow chart, and two small figures (1 and 4 panel). Reviewers only asked us to weaken some claims.

The Cancer Research paper spawned a company and earned my PI an R01. The JNCCN paper was cited just as much, but didn't change anything definitively in practice, and the papers that cited each one were... correspondingly rigorous.

Notice I'm not saying the clinical vs. basic science research is better, just that for most med student research, the rigor-to-IF ratio is much, much higher in basic science. This doesn't really hold for top tier papers in either field. Obviously both NEJM papers and Nature papers are massive undertakings, but it's very true for the majority of research published.

Also, I'd estimate that ~50% of MD/PhD students publish first author papers in journals with IF ~ 15-30. Not plain Nature or Science or Cell, that's just rare in general, but a lot of STM, Cell sub-journals, Nature sub-journals, and tons of Nature Comm, Science Advances, etc... Even placing your full faith in impact factor, I'd bet less than 1% of med students first author a clinical pub in a similarly impactful clinical journal (e.g., Annals, Lancet, or JAMA sub-journals).

 

[Redpancreas]

Will be interesting to see if applications for competitive specialties begin to uptick now that there is no cutoff.

You'll see more self-promotion artists (research, other subjective things) as opposed to anki-clickers.