Why should residents do "research": Part 2, Formulating the question
Formulating a question is arguably the most important step in process of research. Unfortunately, it is the aspect in which the resident/fellow is least likely to be involved. The reasons may include: He is not familiar with the field to a degree that would allow intelligent or relevant questions to be formulated; he, of necessity, is in a corrupt relationship where the research interests of the supervisor are of primordial importance; he has no real interest to be a part of this process; and he has no real intellectual curiosity. Let us look at these in turn.
The issue of unfamiliarity with the field is clearly explicable. A neophyte in cardiothoracic surgery cannot be expected to know what are the controversial issues or the unanswered questions. This justifies a supervisor providing the question to be answered by the research. We all start off this way. As one experiences the process of "asking" the questions and formulating answerable questions, one is hopefully stimulated to ask more questions in the same area and beyond. I believe that a key factor is good communication with the supervisor. The supervisor must allow the resident a glimpse into their mind to see how they come up with the queries.
I do think, however, and unfortunately, that the relationship between supervisor and resident is a corrupt one. The surpervisor wants to answer his own questions and therefore imposes his interests and perspectives. The resident has very little choice. The resident also has his own interests: evaluations, program requirements, career advancement, etc... Ownership of the question by the resident is sometimes lacking and this may result in a failure of motivation. What may be worse is once one becomes more familiar with the subject-matter , one realizes that the question is irrelevant to oneself or entirely.
A resident may not be interested in research at all and may not care to develop research questions. Does this preclude them from being a good surgeon? Probably not, as long as they want to be critical about their own practice and they are evaluating what they do on an on-going basis throughout their professional lifetime. Not everyone will want to follow an academic stream, yet we should engender a sense in all our trainees that being self-evaluative is the minimum acceptable standard and the lowest common denominator. To this end, quality control projects may be more relevant for the trainee population as a whole. This well established process does involve the formulation of questions and is more relevant to the average practitioner. It is arguable that the process of developing a question in this realm is the same as the process of formulating a research question.
The issue of intellectual curiosity is a curious one. As I mentioned in a previous entry, the most intellectually curious surgeon I know wanted nothing to do with academia and research. I believe that very few surgeons posses this quality of true intellectual curiosity. I envision it to be an ideal where the sole motivation for investigation is the personal satisfaction that results from discovery or elucidation, without the corrupting influence of glorification. The reader may now understand why I see so few surgeons having it. Of course, these individuals tend to be supremely intelligent; the sort of intelligence that leads to a self assurance that is not, in fact, arrogant. These individuals will embrace the questions of others and take them at face value and on their own merit, without the fear of competition.
In the end, we have all been given questions to do research during our training. Somehow, we are expected to pick up enough by example and trial and error to eventually develop our own questions: first broad and then answerable. Is this a learnable skill or is this a talent that is not teachable? I cannot say. Nevertheless, we all have some degree of intellectual curiosity, although most of us fall short of the above ideal. At the very least we should try to ask questions that will improve our patient care. And it matters little if they are big-picture or small-picture questions. The objective is identical: to help others.
The issue of unfamiliarity with the field is clearly explicable. A neophyte in cardiothoracic surgery cannot be expected to know what are the controversial issues or the unanswered questions. This justifies a supervisor providing the question to be answered by the research. We all start off this way. As one experiences the process of "asking" the questions and formulating answerable questions, one is hopefully stimulated to ask more questions in the same area and beyond. I believe that a key factor is good communication with the supervisor. The supervisor must allow the resident a glimpse into their mind to see how they come up with the queries.
I do think, however, and unfortunately, that the relationship between supervisor and resident is a corrupt one. The surpervisor wants to answer his own questions and therefore imposes his interests and perspectives. The resident has very little choice. The resident also has his own interests: evaluations, program requirements, career advancement, etc... Ownership of the question by the resident is sometimes lacking and this may result in a failure of motivation. What may be worse is once one becomes more familiar with the subject-matter , one realizes that the question is irrelevant to oneself or entirely.
A resident may not be interested in research at all and may not care to develop research questions. Does this preclude them from being a good surgeon? Probably not, as long as they want to be critical about their own practice and they are evaluating what they do on an on-going basis throughout their professional lifetime. Not everyone will want to follow an academic stream, yet we should engender a sense in all our trainees that being self-evaluative is the minimum acceptable standard and the lowest common denominator. To this end, quality control projects may be more relevant for the trainee population as a whole. This well established process does involve the formulation of questions and is more relevant to the average practitioner. It is arguable that the process of developing a question in this realm is the same as the process of formulating a research question.
The issue of intellectual curiosity is a curious one. As I mentioned in a previous entry, the most intellectually curious surgeon I know wanted nothing to do with academia and research. I believe that very few surgeons posses this quality of true intellectual curiosity. I envision it to be an ideal where the sole motivation for investigation is the personal satisfaction that results from discovery or elucidation, without the corrupting influence of glorification. The reader may now understand why I see so few surgeons having it. Of course, these individuals tend to be supremely intelligent; the sort of intelligence that leads to a self assurance that is not, in fact, arrogant. These individuals will embrace the questions of others and take them at face value and on their own merit, without the fear of competition.
In the end, we have all been given questions to do research during our training. Somehow, we are expected to pick up enough by example and trial and error to eventually develop our own questions: first broad and then answerable. Is this a learnable skill or is this a talent that is not teachable? I cannot say. Nevertheless, we all have some degree of intellectual curiosity, although most of us fall short of the above ideal. At the very least we should try to ask questions that will improve our patient care. And it matters little if they are big-picture or small-picture questions. The objective is identical: to help others.
posted by Luis G. Quiñonez, M.D. at
3:55 AM
1 Comments
