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FEATURED ARTICLE: Research as a Medical Student

FEATURED ARTICLE: Research as a Medical Student AUTHOR: Nina Baier (MD/PhD Candidate), Writer and Editor, radRounds PUBLISHED: October 3, 2008
Interested in pursuing radiology research during your medical school training? Here is a guide and personal anectode that will prove useful for all medical students, not to mention with radiology in mind for their future. It is impossible to recommend participation in research during medical school for everyone. It is also impossible to outline one perfect recipe how to get the best out of research as a medical student. Every medical student has different specific interests, every medical student has to find out by himself if he is interested in research or not, and every medical student will make his own experiences with research projects during medical school. But in my opinion every medical student should consider to try out a short research project, e.g. during a research elective, because aspects you learn in research can exclusively be learned by making own experiences. I can only speak for myself: for me it was the perfect way to get a deeper insight into medicine. I learned how findings from basic research projects can be translated into clinical practice. But I also learned that it is a long way to go and that promising basic research projects might fail exactly for that translational aspect. And even clinical projects, which are close to the clinical practice, might only create irrelevant results for the daily clinic routine. I also learned, in my case, painfully, that one of the most crucial questions for success of medical student’s research is the mentor/principal investigator.supervisor. But let’s start from the beginning!
Background The National Institutes of Health (1) defined clinical research as a broad entity including translational research on human subjects, the development of new technologies, studies of normal and disease mechanisms in humans, evaluation of therapeutic interventions, but also clinical trials, epidemiological and behavioral studies, outcomes analysis and health policy research. In 1997 the NIH published a report on the development of clinical research and especially the participation of medical doctors in this fields. (1) It was found that first-time applications of MDs for NIH grants dropped by 30% during the previous three years proving the long suspected gradual but continuous decline of MDs with interest in clinical research. Among others the panel recommended the following: “If clinical research is to flourish, medical students must become interested in the field.” Therefore programs like the Howard Hughes Medical Institute-supported medical student program, originally only for basic research, were recommended to be established and strengthened in the field of clinical research. In a progress report two years later (2) the same author found that the situation had improved by creating exactly those projects for medical students and by supporting young clinical investigators with a new category of grants. Also others (3) realized that the pool for next generation physician-scientists is to be drawn out of medical students who got interested in research by the opportunity of participating in clinical research projects during medical school. But the most important and decisive point remains to get medical students interested in clinical research, and that can only happen by creating opportunities to get involved.
Personal Achievements What are your personal achievements if you decide to do clinical radiology research during medical school? (4, 5) Above all, you will get a very special, unique and deep insight into medicine and how the daily work in academic radiology can look like consisting of clinical work, teaching, research, and administration. For everyone, but especially those students who are trying to decide between radiology and some other field of medicine, it is a great opportunity to get more actively involved, since students normally do not obtain, interpret or dictate the findings of radiologic exams. You best learn by doing, and during a research project you get the perfect opportunity to learn and practice techniques, which are required skills of any physician, but are rarely taught during a the normal medical school schedule: Before getting started with a new research project, the student must perform an extensive literature search. Thus he becomes familiar with what is on the cutting edge in the field and meanwhile he learns how to read and analyze scientific manuscripts critically. Furthermore the many important parts in research and the great effort that is necessary to produce valuable data never get as clear as by getting personally involved in a study: From identifying an unanswered question in academic medicine to submitting a manuscript it is a far way to go. You need to know what is currently going on in the field and identify a promising topic. On a second step you need to address important and answerable questions and create an appropriate study design to answer these questions. After collecting data and analyzing it, the must be put into a relation to those initial question, meaning they need to be interpreted. Presenting the results to team members and the mentor can be a first great satisfaction on the way to an article. And writing everything up, needs special skills as well: reviewing existing literature about the topic for background knowledge and introduction, formulating the overall question concise and clear, putting the results into words, creating proper tables and figures to support the text, finding an appropriate journal, bringing the whole article into correct format and finally submitting it. One of the greatest hurdles on this way might come at the end if the chosen journal rejects your manuscript, but learning how to handle this challenge is a further important skill that all scientists need to develop sooner or later. Especially in radiology a research project - be it a one-month elective or a full research year – will show the residency director that the student has had a special interest in the field for a longer time, it proves his seriousness of getting involved and learning more than the normal curriculum offers in the pursued field of interest and therefore creates the great opportunity to stand out in a field of highly qualified applicants. (4)
Advice before getting started But what is important in order to make a research project a success? My own experience taught me a challenging lesson by doing research under a supervisor who failed to motivate me, who failed to guide me through the unknown field of data acquisition, evaluation and publication, and even worse who left my medical school during my experiments and did not care about his students after he left. My original motivation decreased continuously, and to try to go on with the project on my own was incredible hard and might have never come to a successful end without my second supervisor who I even found in a foreign country. (My case is not representative for the US, since I made my negative experiences in a foreign country and I did not conduct research in a structured program like they exist now in the US) In my opinion the supervisor is even more important than the potential field of research. Therefore I can only recommend that medical students investigate potential future supervisors, ask other medical students for their experiences with this particular person or ask people in their field of interest for their opinion. It might also be helpful to find out if this supervisor published papers with other student coauthors before. A poll among 4th year medical students who had taken a six-months research project showed that they had chosen their mentor by reputation as role model and teacher (24%), personal qualities (24%), recommendations from other students or faculty (23%), interest in topic (6%) and/or record of publication (2%). (6) Similar to previous publications (5) I also have the opinion that a good mentor should have the ability to encourage confidence and creativity (personal element), be able to focus on pragmatic aspects of professional activity (functional element), show special interpersonal skills and have a good network (developmental element) and actively publish. Or from the perspective of a residency director (4): A good mentor should be able to identify projects that can be completed by students, share an appropriate portion of the project and conduct constructive criticism, and hold regular meetings with a structured review of work completed thus far, a mixture of praise and constructive suggestions for improvement and develop a list for the next steps together with the student. Recently I found a checklist of advices and questions a student should ask himself before getting started in order to get a better idea of what might be important (7):
- Be aware of the scope of your research project, including its length – will it take months or years to complete? * Choose a smaller project rather than one that will be (or looks likely to become) complex and demanding. * Make a personal commitment to finish the research. Choose an area of interest to you, irrespective of other pressures and suggestions
- Research your potential research advisor * What is her or his track record on grants and publications with other student coauthors? * Has he or she been responsive and supportive to previous students? If so, were the responses timely?
- Make contingency plans for things that may go wrong. * Stay in touch: communicate often with team members * Coordinate with your teammates to guarantee a single “hot copy” or active draft of the paper, to avoid developing parallel versions. * Back up your data regularly; store a copy offsite.
- If you find that research is not your “thing”, investigate other means to achieve your career goals.
Publications Of course a medical student’s overall aim in doing research is to publish his own results. Nothing gives more confidence and satisfaction than seeing his own work printed in a journal. But are publications - maybe even as a first author - realistic during medical school? This year a study was published (8) that answered exactly this question. Among medical students who had conducted a full year of research during medical school (mostly before starting the fourth year), 51% had published at least one paper and in 68% of those publications the medical student was first author. But overall only 23% of students were able to publish in time for residency application, and only 13% achieved this aim as first authors. As long as both medical students and residency directors are aware of this fact, performing a research year can only be an enrichment for the students, for medical schools offering research programs and for the whole medical research world and research during medical school and thereby getting future MDs interested in research might solve the problem of decreasing numbers of MDs who are involved in clinical research.
by Writer and Editor, Nina Baier - radRounds.com
1. Nathan DG. Clinical research: perceptions, reality, and proposed solutions. National Institutes of Health Director's Panel on Clinical Research. JAMA 1998; 280:1427-1431. 2. Nathan DG, Varmus HE. The National Institutes of Health and clinical research: a progress report. Nat Med 2000; 6:1201-1204. 3. Ley TJ, Rosenberg LE. The physician-scientist career pipeline in 2005: build it, and they will come. JAMA 2005; 294:1343-1351. 4. Pretorius ES. Medical student research: a residency director's perspective. Acad Radiol 2002; 9:808-809. 5. Sonners AI. Value of a radiology research rotation: a medical student's perspective. Acad Radiol 2002; 9:805-807. 6. Frishman WH. Student research projects and theses: should they be a requirement for medical school graduation? Heart Dis 2001; 3:140-144. 7. Detsky ME, Detsky AS. Encouraging medical students to do research and write papers. CMAJ 2007; 176:1719-1721. 8. Cohen BL, Friedman E, Zier K. Publications by students doing a year of full-time research: what are realistic expectations? Am J Med 2008; 121:545-548.

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Comment by Mohamad Kurani on October 10, 2008 at 9:11am
Hello Dr Nina. This is a great article. I am an IMG radiologist with2 years postgrad experience, permenant USA resident soon, passed USMLE step1 and 2CK and planning to continue my life in research. I need your advice, which research centers can take juniors like me. Thank you for help.

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