Comprehensive Guide to Research from the Perspective of a Medical Student

Guest post from Dmitry Zavlin, MD, a research fellow in Houston, Texas. He has been highly productive in his research endeavors and below describes a comprehensive guide to getting involved in research.

Background

Without any doubt whatsoever, high USMLE scores, strong recommendation letters from faculty members, a multitude of away rotations, and an updated and accurate résumé make up the foundation of a strong application for a residency position. Nevertheless, from my personal experience, one topic remains crucial that many medical students either love or hate (or try not to think about it): research. It is an extracurricular activity that enables someone to stand out from the crowd and present oneself as a diverse and multitasking character. These traits are especially favorable when it comes to applying to competitive residency programs with high applicant to position ratios. I encourage every future graduate to look into this topic since – and as astonishing as this may seem – medical school is the ideal opportunity to get your name out there. You don’t need to take a year off from classes or be on an M.D., Ph.D. track. Even those students that do not seek academic careers have a benefit from engaging in scientific duties. It helps you understand the mechanisms of research, the bureaucratic obstacles, the medical challenges, and teaches you communication with peers and faculty. Furthermore, you learn how to read, analyze, and interpret scientific publications of others. And trust me, it’s not all gold that gets printed in journals. On first glance, getting involved in unpaid ventures while you are in class, on rotation, at home studying or just taking some time off for yourself might seem like a bad deal. Yet with a sincere approach towards this subject, you can strengthen your résumé, top off your application, and learn skills that will serve you well into your career as a doctor.

The following lines are intended to display my personal experience that I have made at my medical school and in my interactions with students, residents, fellows, and attendings at my current position.

Choosing your Project

First things first. Naturally, you would want to participate and conduct research in a field of medicine you might see yourself in after graduation. However, as mentioned before, this is not a K.O. criterion. Plenty of personal experiences tell me stories of students who were involved in one area and then switched and matched in a completely different specialty of medicine or completely left the patient-care sector. Therefore, consider your engagement in scientific tasks more of as a symbolization for your work ethic and your ability to perform in a team.

My first tip is to contact the department at your home medical school, introduce yourself, write 1-2 sentences describing your motivations and goals, and ask to sit down with some faculty members or scientific staff to discuss your involvement in any research activities.

Larger departments usually have secretaries or an academic office where your email is less likely to get lost compared to the inbox of a busy professor who receives hundreds of emails per day. Personally, I would aim for junior faculty and potentially senior residents who are experienced enough to conduct research on a high level but are not too far away from the life of a young medical student. Certain departments further have specific full-time research staff that is definitely a great resource for any scientific venture. While it may be helpful to work with the director and senior faculty directly, the sad reality is often that they typically have many academic and administrative duties and activities at their institutions that might not go along well with the schedule of an ambitious student and cause frustration in the long run.

When you meet, make sure to gain and write down as many details as possible:

• What is the topic, what is the goal of this project?
• What type of format is it? (See below)
• What is the current status?
• Who is involved in this research project, what is the team, what are the people to contact?
• What will be my duties?
• Any bureaucratic issues to be aware of (IRB approval, grants, finances)?
• What is the prognosis? Are there any deadlines?

Lastly, ask about the current literature on that topic so you know what your team’s role is going to be in this scientific field. Although one core concept of any research result is reproducibility, it often remains a challenge to publish a project that has already been performed and presented or printed before. Getting involved in an area that is in quick development with high turnaround is subsequently a strong recommendation.

Types of Evidence-Based Research

Now, I would like to talk about the most common options you will encounter when presented with an array of project offers. That way you know their perks and pitfalls before you commit to anything serious and long-lasting and potentially even waste any valuable and limited time of yours.

• Case Reports: These are the most basic and least powerful of scientific contributions to medicine. Give or take, a case report is the summarized hospital or clinic chart of a treated patient who presented with a problem A and was managed with therapy B. A case report that is typically 2-3 pages long with a short intro, a compact case discussion, and perhaps some photos is the closest thing you will get to a patient note you learned to write in early medical school. Their lack of medical value makes them hard to get published in journals and students should not solely rely on these projects as they may not ultimately be accepted by journals. Recommendation: 3/5

• Case Series, Retrospective Study: These layouts are my personal recommendation as they allow quality results within a short period and are not time-consuming or require large long-term commitment as others. Typical examples are an analysis of patients who presented with the same diagnosis or underwent an identical procedure. The difference between a case series and a retrospective study is that for the latter, the patients can be stratified into different subgroups (similar to “case control study”) and statistical calculations can be performed to achieve significant conclusions. Recommendation: 5/5

• Prospective Studies: In these studies, patients are gathered in one or multiple cohorts and are followed-up over long periods of time by lab results, imaging, physical exams etc. These require great time commitment and, from a student perspective, typically only allow a certain amount of participation. These are usually studies for physicians with long relationships with their patients. Recommendation: 3/5

• (Randomized) Clinical Trials: The peak of evidence-based medical research. Similar as prospective studies yet require more planning, IRB approval, and lots of work with industry, grants, protocols, etc. Student involvement is usually marginal. Recommendation: 2/5

• Basic Science, Animal Work: Although these projects require training, approval, and a large amount of preparation, student participation is common in many areas of basic science. The advantage of these laboratory activities is a certain amount of flexibility on when certain tasks and duties can be performed. Within certain limitations, a medical student can get involved in animal or basic science research and assist in specific jobs suitable to his or her personal schedule. Even partial involvement can be enough to get one’s name on a publication. However, lab work can be monotonous and frustrating at times when experiments do not deliver the anticipated results. Sitting in non-stimulation laboratories requires a certain type of character. Recommendation: 4/5

• Descriptions of Innovations: Purely descriptive publications of new surgical techniques, innovative technology, new pharmaceutical drugs, or simply personal statements on evolving subjects, etc. This type of work often demands a given level of expertise and is not typically suitable for graduate research. Recommendation: 2/5

• Reviews, Meta-Analyses: These types of written compositions are based on a literature review. The author’s job is to read through countless, often hundreds of previous publications and create a summary regarding a specific medical topic. Reviews and meta-analysis are particularly useful for issues that are prevalent and have delivered many reports in the past. Whereas a review merely lists the findings of previous research groups, a meta-analysis is able to pool data and conduct statistical analyses. These projects allow great flexibility and can be finished from any location but do not underestimate the time needed to achieve proper results. Recommendation: 4/5

Formats of Publication

What follows is a list of mediums that allow you to get your work to the public. Albeit the concept of most research activities is similar and progresses on akin paths, it is important to agree on a goal early in the research process. Journal articles, for example need to be of highest quality and impeccable when submitted. Presentations must be tailored accordingly depending on what audience you are planning to address. Book chapters need clear guidelines to ensure that your handiwork fits well to the other parts of the volume. Make sure to discuss this topic with your seniors to understand their expectations from you.

• Journal Articles: These are the highest quality format that you can use to submit your research work for the world to see. Upon arrival at the journal’s office, the editorial office first reviews your manuscript and determines its eligibility. Next, it is sent off to a number of anonymous reviewers who judge your documents and suggest if it is worth publication, if it needs changes, or if it should be rejected. Being an author on articles in peer-reviewed journal is the strongest support to improve your application. Recommendation: 5/5

• Podium Presentations: These are typically 5-15min PowerPoint conferences or similar in front of regional, national, and international audiences of students, residents, nurses, scientists, and board-certified physicians. While your work might be less accessible to the world than published articles, it is still recommended to submit your accomplishments to such conventions. Aim for national conferences rather than regional ones. Recommendation: 4/5 for (inter)national, 3/5 for regional conferences

• Poster Presentations: A classic poster session is where you travel to a conference, hang your poster with a summary of your research findings (similar to a short abstract) and are available for others to review your work and ask questions. In some cases, poster sessions are requested by conferences when you apply for podium presentations but your projects are not considered beneficial enough. Recommendation: 3/5

• Book Chapters: Senior physicians, faculty members, or experts on a certain field are sometimes asked to write segments of medical or scientific books that are soon to be brought on sale to the market. In certain cases, students or residents write segments of such book chapters for the senior author. From personal experience, these projects are a long-term process as they go into extreme medical detail. On the upside, publication with your name on it is almost guaranteed. Unfortunately, these types of publications are not of high evidence-based research and should only be considered as a secondary side project Recommendation: 3/5

Basic and Necessary Know-How

After choosing your project you need to learn and understand how the scientific process works once you have your results ready for publication. Conducting the studies, experiments, and the literature reviews is one part of the research job. Presenting your findings is the other side of the coin. Read many publications on the same subject and study what a paper is supposed to look like. Analyze the language the authors use. It has to be straight to the point, factual, objective, leave out unnecessary information yet avoid long soporific segments of repeating details. Your audience will want to hear a hypothesis, the methodology of your venture on how said hypothesis should be tested, your results, and an antiseptic interpretation thereof. Having a senior writer review your work is therefore crucial in the beginnings of a research career.

Next, and this may seem like a no-brainer, learn how to properly and efficiently use today’s available technology to your advantage. Learn the most important features of your word processing software. Get access to a tool that allows to sort and list literature references and full versions of articles, preferably in PDF format. If you share files with others or work simultaneously at different sites, use a cloud service to keep your files in synchronization across all your devices. Any photo, video, or graph-editing software with some artistic skills might come in handy as well. Lastly, learn some basic mathematical and statistical skills and obtain a statistical software. Research is nothing if you cannot back up your story by some hard numbers. Study what a t-test, a type I error, and a type II error are and how they work. Understand when you have to use chi-square and when the Fisher’s exact test. This list goes on and on. You do not need a Ph.D. degree in biometrics or stochastic calculus to be involved in medical research but even basic skills can set you far ahead of others and you will stand out from the crowd. Additionally, all these things I just mentioned facilitate your projects by incredible amounts and allow you to publish your results faster. Capitalize on the technology that is available today!

Finally, learn how to revise current literature and how to look for references to back up your ideas or contrast your data to those of other groups. In the end, research is a competition almost like any other business sector; except that money is not necessarily the number one objective but rather prestige and impact. Pubmed is a valuable search engine, for instance, that allows you to go through the MEDLINE database and find similar publications to your project. UpToDate is a practical tool that is constantly refreshed by countless experts and gives access to the latest guidelines on specific topics. One of my former attendings always said that publishing a paper is like selling a car: you have to know the market and emphasize the upsides of your work to gain interest of others. Have all these files clean and tide on your computer from day 1, so you can keep a good overview of things and track your progress.

Further Aspects to Consider

When you start a new research project, figure out who your team is that you will be working with as this will determine the authors and their order on a potential publication. Make sure your name appears on the final manuscript if you have brought significant effort and input towards the project. As the New England Journal of Medicine, one of the largest and most prestigious journals in the field, states:

“Credit for authorship requires (a) substantial contributions to the conception and design; or the acquisition, analysis, or interpretation of the data, (b) the drafting of the article or critical revision for important intellectual content, (c) final approval of the version to be published, and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved.”

The more work you put in, the further your name should appear up front. The final position of a scientific publication is usually reserved for the senior author (principal investigator) and the head of the team.

The last issue that needs to be mentioned here are finances. Even if you are working on a retrospective study and are just simply scrolling through patient charts to gather data, special software, travel to conferences, fees for journals (author processing charge for open access) can rapidly add up. Basic science ventures may require additional funding. Knowing your resources is crucial for any research. The discussion of money may seem like a sensitive subject and “above your pay grade” yet I recommend approaching this topic with open cards when the right moment comes.

Final Words

Despite the downsides of scientific work, I still believe the majority of students should experience the art of research that has made medicine what it is now. Yes, research is frequently frustrating and consumes many of your physical and mental resources. Yes, a majority of jobs after residency do not include research. Still, I will never forget the great feeling of my first accepted publication and when I immediately continued to strive towards the next challenge. Henceforward, research had something rewarding and appealing about it. In the long run, this highly dynamic profession is probably not suited for all future physicians, yet I can only repeat myself and encourage everyone to give it a try.

Dmitry Zavlin graduated with an M.D. from the Technical University of Munich in 2015.

He currently works as a research fellow in Houston.

To contact the author, please visit www.zavlin.com