So you wanna do research huh?

So I recently somewhat stumbled onto two research projects, which are currently eating up a lot of my free time, and thought to myself “Self, this would be a good topic for a post.”  So here we are.

When applying to medical school, many students become adept at “fluffing” up their CV on their AMCAS application.  So what if you only went to the Save Ugandan Tortoises Interest Group meeting once?  It looks great to application committees; add it to your activities!  Luckily (or unfortunately, depending on your fluffing skills), residency programs are much less interested in having you fill up your ERAS application with BS and are much more interested in firmer aspects of your resume, such as board scores, clinical grades, and letters of recommendation.  Research is one piece of the puzzle whose importance is highly debated among medical students.  One of the first questions out of the mouth of more ambitious freshly minted MS1s, still dripping with the sweet dew of the World Outside Medicine, is “How can I get involved in some research? I need it to get into a good residency.”

There are a myriad of opinions on the necessity of doing research in medical school, whether it is more fluff or substance.  There is plenty of n=1 evidence of individuals able to land top spots in tough fields without it, as well as evidence to the contrary.  Like most things in life, the truth likely lies somewhere in the middle, and how much you “need” research on your resume when applying for residency is highly program and field dependent.  Unfortunately, I have yet to find a good website or book with that kind of information.  The best approach I’ve found is simply asking around amongst individuals further up the food chain.  Residency directors in particular are invaluable resources for giving you a good sense of what you do and do not need to do during your first 3 years to make yourself into a solid applicant, as well as the tastes and preferences of various programs.  That being said, the NRMP website has a plethora of data available about characteristics of applicants who successfully match into each specific field, broken up by board score, state, amount of publications, shoe size, hair color, etc.  One thing to keep in mind when viewing the data is that variables such as total number of publications tend to be skewed upwards in the more competitive specialties, as they tend to attract a greater proportion of the “super applicants” with pub lists larger that the US National Debt.  For example, the mean number of abstracts/presentations/etc for ENT last year for successfully matched applicants was 4.1.  But the mode of the pool of successfully matched applicants is lower than the mean due to the “drag effect” of the upper crust, so it does not necessarily mean you are “below average” if you are applying into ENT with less than 4.1 pubs. However, the NRMP data is useful for broadly comparative purposes, where you can construe that research is more important to match into ENT than family medicine (avg 2.8) but less important than rad onc (avg 8.2).

So where does ENT sit on the spectrum on research-loving/research-hating?  The consensus I’ve received after talking to various faculty is: research isn’t essential for matching into ENT, but it’s pretty important.  The field as a whole tends to highly value research.  Part of that is due to the smaller size of the specialty – it is much more reliant on broad participation in clinical research to contribute to the common knowledge of the field.  Part of it is the rapidly evolving nature of the field.  Part of it is that residency programs pride themselves in being academic pipelines and being responsible for training the future department chairs of the world.  The simple fact is that nearly all ENT residencies offer some form of dedicated research time in their residency track, and most require their residents to be working on at least one study while in training.  It is an asset when a resident has sufficient experience from medical school to be able to jump in and tackle a solid research project while at said residency’s program, rather than having to learn the ropes on the fly.  Can you match into ENT without any research experience?  Sure, and many have, but it requires having something else to compensate (be it above stellar board scores, above stellar letters of recommendation, etc).

So, you’re sold, you want to do research.  What does that even mean?  How does one even begin to “do research?”  That’s the situation I found myself in my first two years of med school.  My experience with research prior to med school consisted of running PCR gels in a lab, and unfortunately my school did not do much in terms of educating us of our options during the pre-clinical years, besides telling us to “get involved!” and spamming our inboxes with a bunch of vague emails.  So I floated through my preclinical years, feeling slightly guilty I wasn’t in on this “research” bit but having no idea where to start.  When I became pretty sure I wanted to go into ENT, I knew getting involved in some research would probably be a good idea, but wasn’t sure where to begin.  Luckily, I found out it can really be as simple as sending an email.  Most faculty in an academic setting have a project or two going at any given time, and at least a couple questions they would like to investigate.  And if they don’t, they tend to know who in the department does and are looking for medical students to help.  The main thing is to just be proactive; there’s a wide myriad of opportunities, but you need to find that point of first contact.  Your “in”, so to say.  Whether that is replying to a “research opportunity” email, talking to a contact in the dean’s office, or an un-solicited message to an attending you may know in a department you may be interested in, I’ve heard of successes with any and all of the above strategies.  You don’t even have to commit to a project, but once you open the dialog there is often a great deal of flexibility in how much time and energy they will let you contribute.  But no one is going to give you research opportunities if you don’t ask, so the onus is really on you as the student in the beginning.  If you’re not sure where to start with research, the Medical Student Research FAQ over at Student Doctor Network is a good place to start.

I was chatting with the ENT program director at my school the other day and I asked how he was able to differentiate between such a large pool of highly qualified applicants, all with research on their CVs. Here were a few of the things he told me they look for:

1. The more responsibility you have over the study, the better

The ideal, of course, is that you started with a question, formulated that into a hypothesis, structured a research design to answer that question, got the protocol approved through IRB, collected and crunched all the data, worked with a statistician, wrote your article, and got it published.  Of course, with both the time and resource constraints of medical school, and the limited timeline we are on to score a publication, such a scenario can be largely unrealistic.  But what it comes down to is: what you end up researching is less important than the experience you gain during the process.  Are you familiar with all the steps that are involved with taking research from idea-to-publication?  Can you create a solid study design?  Are you experienced in writing publications?  The most obvious way you can demonstrate these qualities on a residency application is to be either first or second author on a publication.  But first and second author opportunities are few and far between for students, and often more a consequence of luck.  That being said, you will be asked about your research during your interviews, and being able to speak intelligibly about your project(s) will go a long ways towards demonstrating that you would be a competent researcher.

2. Get some funding

There’s a surprising amount of money out they for medical students doing research who are up to the task of writing an application for the award.  It doesn’t even have to be a large sum, a couple thousand dollars is sufficient.  But the nice thing that a grant or award demonstrates is an additional level to the vetting process of your study.  It shows that an independent body evaluated your study and decided it was a worthwhile enterprise.  This does a lot towards legitimizing your work in the eyes of program directors.  Your dean’s office is likely your best bet if you’re looking for a few leads on some awards you can apply for.

3. Sell your experience

Like I said before, what you end up studying is much less important than your experience in doing research.  PDs want to see not only that you’re competent, but that you’re excited and engaged in the research process.  Being able to discuss both the skills you’ve gained through the process and what about doing research intellectually challenges and stimulates you demonstrates an additional aspect of what would make you an asset to their program.

As for my own personal experience – I got my “in” by emailing an younger attending in my department who I had gotten to know through our clinical skills class during the pre-clinical years.  We set up a meeting and he laid out a few study questions he had been considering and let me pick up a project I’d like to take up.  I ended up taking on two different studies (that have now evolved into three studies) and have been the point man as far as getting IRB approval, writing consent forms and proposed project protocols, collecting data, and such.  Let me say, if you can snag yourself a similar experience, it’s a lot of fun.  Being the person in charge of the nitty-gritty details gives you a large appreciation for the research process and causes you to ask yourself a lot of the questions that differentiate a well-designed study from a haphazard one.  Plus in medical school, where you often find yourself busy with tasks that feel mundane or pointless, it’s a pleasant experience to be involved with something that feels meaningful.  You get to be the master of a small subject, and you’d be surprised the many ways you can spin that into talks, posters, and papers along the way.  I wasn’t particularly enthused with research before getting involved with all of this, but since then have found my clinical curiosity kick up a few notches and encountering all sorts of questions in the clinical world that would make for interesting studies.

Well, that’s it for now.  Until next time!