Why should residents do "research" during training? Part 1, Introduction
Residents in cardiothoracic surgery are highly encouraged, persuaded, pressured, or even mandated to do some form of research during their training. From my inexpert and inexperienced perspective, "doing research" means: formulating a question; critically appraising the relevant literature; designing the best protocol to answer this question; executing the protocol; analyzing and interpreting the results; formulating conclusions; presenting, defending and publishing the findings.
What purpose does this serve? What is the value of doing any form of research during residency training? What are the educational objectives behind performing research?
In an idealistic setting, research is done to promote academic curiosity and critical thinking, whatever these things mean. In a realistic setting, it is done because it may be required in order to complete training; in order to get a better job or fellowship (career enhancement); or to kill time until a desired position comes up. In fact, I have only met a small number of residents with a genuine academic curiosity and who did research for the sake of fulfilling this curiosity. Ironically, the one I considered the brightest, talented and most intrinsically motivated for this endeavour decided to get away from the academic world and do community practice. He was not interested to "play the game". He is one of the most balanced individuals I know. Scott, you have my deepest respect. It was a certain institution's heavy loss.
I would be interested in following residents who have done surgical-scientist programs or doctorate degrees during residency. How many of them end up doing research? How many of them are academic surgeons? How many of them would do it again? Are they better surgeons and if so precisely how? How do their surgical results compare with non-academically trained surgeons? The answers to these questions may surprise and displease some. Even asking them may offend others. Yet, if we are to take young residents and commit them to this investment in time and energy, should we not measure the outcomes to see if it is "cost-effective" for the resident and the healthcare system?
What training programs are trying to accomplish by having residents do research? A cynical view is that it provides cheap labour for their laboratories and workhorses to do chart reviews. Cynicism aside, the underlying assumption, I believe, is that doing research promotes critical thinking and develops critical thinking skills that can be translated to a clinical setting. It is also a way to identify talented individuals for that endeavor.
Critical thinking in clinical medicine may be defined as a process that leads to the systematic assessment of one's practice. In practical terms it involves identifying problems in one's practise, appraising the available literature, coming up with ways to solve these problems, instituting solutions and assessing the results of interventions. Problems may also be questions and these are approached in the same way.
I propose that critical thinking in the clinical setting overlaps with the research method, however formal research training is not necessary to become critical thinkers in our practise. I must go back and re-state the definition of "doing research" that I submitted above: formulating a question; critically appraising the relevant literature; designing the best protocol to answer this question; executing the protocol; analyzing and interpreting the results; formulating conclusions; presenting, defending and publishing the findings. All these steps I will discuss in turn in subsequent weblog entries and argue that the objective of critical thinking and the obtaining the skills involved can be taught in a residency training program without the need or obligation to spend time doing clinical or basic science research.
What purpose does this serve? What is the value of doing any form of research during residency training? What are the educational objectives behind performing research?
In an idealistic setting, research is done to promote academic curiosity and critical thinking, whatever these things mean. In a realistic setting, it is done because it may be required in order to complete training; in order to get a better job or fellowship (career enhancement); or to kill time until a desired position comes up. In fact, I have only met a small number of residents with a genuine academic curiosity and who did research for the sake of fulfilling this curiosity. Ironically, the one I considered the brightest, talented and most intrinsically motivated for this endeavour decided to get away from the academic world and do community practice. He was not interested to "play the game". He is one of the most balanced individuals I know. Scott, you have my deepest respect. It was a certain institution's heavy loss.
I would be interested in following residents who have done surgical-scientist programs or doctorate degrees during residency. How many of them end up doing research? How many of them are academic surgeons? How many of them would do it again? Are they better surgeons and if so precisely how? How do their surgical results compare with non-academically trained surgeons? The answers to these questions may surprise and displease some. Even asking them may offend others. Yet, if we are to take young residents and commit them to this investment in time and energy, should we not measure the outcomes to see if it is "cost-effective" for the resident and the healthcare system?
What training programs are trying to accomplish by having residents do research? A cynical view is that it provides cheap labour for their laboratories and workhorses to do chart reviews. Cynicism aside, the underlying assumption, I believe, is that doing research promotes critical thinking and develops critical thinking skills that can be translated to a clinical setting. It is also a way to identify talented individuals for that endeavor.
Critical thinking in clinical medicine may be defined as a process that leads to the systematic assessment of one's practice. In practical terms it involves identifying problems in one's practise, appraising the available literature, coming up with ways to solve these problems, instituting solutions and assessing the results of interventions. Problems may also be questions and these are approached in the same way.
I propose that critical thinking in the clinical setting overlaps with the research method, however formal research training is not necessary to become critical thinkers in our practise. I must go back and re-state the definition of "doing research" that I submitted above: formulating a question; critically appraising the relevant literature; designing the best protocol to answer this question; executing the protocol; analyzing and interpreting the results; formulating conclusions; presenting, defending and publishing the findings. All these steps I will discuss in turn in subsequent weblog entries and argue that the objective of critical thinking and the obtaining the skills involved can be taught in a residency training program without the need or obligation to spend time doing clinical or basic science research.
posted by Luis G. Quiñonez, M.D. at
4:55 PM
3 Comments:
For someone who is essentially against research (by your own admonitions herein and at least in so far as the whole 'game' is structured today), you sure ask a lot of research questions!
You even display your critical abilities by nicely explicating what research is (only as an ideal I would argue, as it takes much more than just identifying the steps one must take).
So will you ever take the steps (beyond just theorising them) to understand and answer your fundamental and incredibly interesting research questions (for the betterment of others and the system as is necessary for you)?
Probably not, as you seem to not like 'the game' (even though you were made for it), or have the patience for what it really takes to be a complete critical thinker (ouch!).
Once again, too smart for your own good, lacking the empathy needed to critically understand that, what you take for granted (i.e. critical thinking), is not a skill everyone is blessed with (as you intimate, not all surgeons are critical thinkers!.
So while such complexes may be easily grasped by you, don't derogate other people's educational and intellectual opportunities (even if they do observe them as a hassle), simply because of a distaste you may have acquired from yourincredibly limited and narrow experiences (this is a normative statement applying to all individuated experience, not just yours).
Again, I would argue that what is easy for you, is not necessarily teachable without making one undertake the research process, and if it is teachable, it becomes so through this process (or at least becomes pedagogical in a much easier fashion as compared to something else, an alternative which you have yet to present).
In fact, I'm curious to know how you developed your critical skills? Was it not through doing research?
In short, you'll have to provide much evidence to convince me otherwise.
Nonetheless, I very much look forward to your attempts, as I know if anyone can do it, it is you.
I find it not surprising that you feel so strongly about mandated research as likely you feel the pressure to undertake it :) Consider the perspective that it is part of trying to broaden residents' educational experiences and exposing people to alternate viewoints (not only that of surgical attendings). I believe that "academic enrichment" is a good idea, however, individuals must be free to librally interpret this concept so that the experience can be adjusted to meet different goals and objectives. Research is designed to foster "critical thinking", but it is also used to promote individual's growth and to broaden their perspective on medicine. To simply assess it in a "cost-effective" analysis is unfair and too rigid.
It is also interesting that you seem to have such high respect for "Scott" who is so well balanced, however you show yourself to be very skewed - at least when it comes to research.
Insert applause for bjr here!
:)
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