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How to make the most of research during residency

Choosing a topic that's right for you is key to getting all you can from your scholarly pursuits

From the April 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Christine Kuehn Kelly

When Mark T. Knower, ACP-ASIM Associate, was asked by the Alton Ochsner Medical Foundation's director of lung transplantation to take on a drug-related research project, the New Orleans resident jumped at the chance.

"I had already done lab research as a medical student and enjoyed it," Dr. Knower recalled. "And I find clinical research even more enjoyable, especially the patient interaction."

The project eventually led to an award-winning poster presentation at Annual Session last year and encouraged Dr. Knower to seek a fellowship in pulmonology.

According to residents like Dr. Knower who have done research projects, the right project can enhance your training experience. Foremost, you get a chance to explore a specific area in medicine while working with experts in the field, which helps you stand out when it comes to applying for fellowships and jobs. If your project is noteworthy enough, you may end up representing your institution at a regional or national level.

You will also learn more about your topic than you have ever learned about any subject before. "Many residents have told me that doing research was their chance to learn something in depth," said Patrick C. Alguire, FACP, the College's director of education and career development. "They have even become the local expert in the subject. The topic may be narrow, but their knowledge runs deep."

But perhaps most important of all, doing research tends to make you a better physician, according to experts. "Medicine is not only a caring profession, it is based on scholarly research," explained Gregory A. Poland, FACP, professor of internal medicine and associate program director of the Mayo Clinic and Foundation internal medicine residency program. Research and scholarly projects help residents think more critically, a skill that they will use throughout their careers. "Learning how to ask questions, test hypotheses and analyze data is the key to lifelong learning," Dr. Poland said. "It's the infrastructure for everything else."

When residents finish their residency, he explained, the only way they learn new information is by reading about it or hearing it from someone else. "We want to make residents understand where patient decision-making comes from, and the limitations of the available information," he said. "How can they verify its accuracy? And how can they generalize it to the patient sitting in front of them? Without the right interpretation, they can hurt people."

Picking a topic

Your first task is to identify a topic that you find interesting and that is worthy of further examination. "Every day on the ward there are novel cases or an unusual presentation of common problems that present clinical questions," said Dr. Poland. With a little scholarly activity, he added, many are publishable or presentable. Also, keep in mind that peer-reviewed journals are not the only outlet for your research activities. You can also make your results available in abstracts, posters and slide presentations.

Another consideration in choosing a topic is whether you'll be able to prove a specific finding. Dr. Knower said that his poster showed cost savings, safety and efficacy in drugs used for lung allograft recipients. He felt his research succeeded because it was a "straightforward idea with clean results. We proved what we wanted to prove."

Melinda J. Muller, ACP-ASIM Associate, a third-year resident at Legacy Healthy System in Portland, Ore., won at last year's Annual Session Research Poster competition for her presentation on medical students' attitudes toward homosexuality. She got the idea for her project from her own experiences as a gay medical student. "It was a topic I was extremely interested in and in which my advisor's help was invaluable," she said. As a result of both her interest and her success in this research, she plans to do further work on the subject.

Finally, the feasibility of a topic is also important. You need to design a study that has enough available subjects and that you can complete with the available time, money and technical expertise. Areas like molecular biology, for example, take a lot of lead time to learn methods and produce results, said Richard N. Kitsis, MD, an associate professor of medicine and cell biology and director of the molecular cardiology program at Albert Einstein College of Medicine in New York. Choose a topic you have a better chance of bringing to fruition.

Help from mentors

Mentors can be another key to the success of resident research. Robert S. Crausman, ACP-ASIM Member, director of the primary care general internal medicine residency at Brown University School of Medicine/Memorial Hospital of Rhode Island, said that mentors can help residents decide which topics will pan out and which ones will contribute to scientific knowledge or health policy. The program has one faculty mentor for each of its 32 residents, and the mentors also help with methodology, data collection, analysis and writing.

Dr. Crausman said that when looking for a mentor to help with research, try to find someone who is an active scholar and has an open mind. "A good mentor has to have a personality that meshes with the resident's," he said. (For more on mentoring, see "How mentors can enhance your training and career," from the November 1998 issue of ACP-ASIM Observer on ACP-ASIM Online at www.acponline.org.)

Pairing mentors with young researchers seems to be working at Brown. Of the program's 32 residents, there have been 23 resident-authored publications during the last four years. Publications have ranged from case reports, brief communications and review articles to formal research reports in a variety of journals including Annals of Internal Medicine, CHEST and Diabetes Care.

Mayo also encourages residents to find mentors and even provides housestaff with a research manual that lists research mentors and their projects. And although Mayo residents are required to complete only one project, Dr. Poland noted that the average for last year's graduating class was 3.1 projects per resident. "They really get turned on by being a part of generating new medical and scientific knowledge," he said.

Residents in VA systems or community-based programs may have to work harder to find a mentor who is research-savvy. If you're having a hard time finding someone in your institution, Dr. Kitsis said, try searching its Web site for other research related to your own project. You may find someone who has experience with your topic who is willing to serve as a mentor.

Here are some other tips to help you get started with a research project:

  • Plan to spend extra time. A few programs dedicate time just for resident research. At Brown, for example, residents devote one week in their first year to planning research projects. In their second and third years, the residents work on projects more longitudinally, and those who need more time can restructure their schedule to accommodate their research needs. But even at Brown, residents burn the midnight oil and work weekends to finish their projects.

    That's because no matter how much time you plan, you'll find that to do really good research projects, you'll almost always need extra time.

  • Expect false starts. "I got into my survey and found I had forgotten a crucial point," said Dr. Muller. While mentors can help avoid unnecessary work, she said that even false starts are good learning experiences.
  • Seek public acknowledgment. Most programs try to showcase resident research in some way. "You need a venue to display and show off your hard work," said ACP-ASIM's Dr. Alguire. "It's a hugely important reward."

Christine Kuehn Kelly is a Philadelphia-based freelance writer specializing in health care.


Planning for ABIM's research pathway

For physicians who wish to pursue a career in basic science clinical research, the American Board of Internal Medicine (ABIM) Research Pathway combines training in research with training in clinical internal medicine. Trainees in the research pathway must complete two years of accredited internal medicine training, one to two years subspecialty training, and at least three years research training. Trainees must spend at least one-fifth of their time during research in clinical experiences.

Ideally, planning for appropriate research training should occur during a resident's first year of training, and ABIM should be notified of a trainee's intentions by the spring of the second year of training.

For copies of ABIM's research pathway publication, contact ABIM at 215-446-3598.


Tips for fine-tuning your poster presentation

If you are planning on presenting a poster, slide show or research paper at a local conference or a national meeting, try the following tips from successful poster winners:

  • Perfect your oral presentation. Know the time limits and keep your presentation within the within the allotted time. Before you officially present the poster or slide show, make several practice runs. Practice in front of a mirror, other residents or your advisor and time yourself.
  • Get feedback. Residents whose projects were presented at last year's Annual Session Research Poster competition said that they continually refined their work as they put their posters together. The refinements were often based on how faculty and other residents perceived the work-in-progress.
  • Be concise. Avoid extraneous information that doesn't relate to the topics, said Mark T. Knower, ACP-ASIM Associate, a resident at the Alton Ochsner Medical Foundation in New Orleans. Make the poster easy to read and understandable at first glance. Use the least amount of data necessary to make the point.
  • Don't depend on elaborate design. Although a well-laid out presentation is essential, your work doesn't necessarily need to look like it came from a graphic designer's portfolio. Some 1998 Annual Session poster winners included elaborate, multicolored presentations, but residents with more basic black-and-white abstracts and posters were also successful.
  • Be prepared for questions. Melinda J. Muller, ACP-ASIM Associate, a third-year resident at Legacy Health System in Portland, Ore., said that she thoroughly researched additional aspects of her topic and was prepared for questions about similar research. "I had answers ready, and I needed to use them at the poster session," she recalled. "Fortunately, my advisor had taken me through the routine so often, I felt very comfortable."

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