4 How to Prepare for a Period in Research
Fortune favors the prepared mind. – Louis Pasteur One sometimes finds what one is not looking for.
– Alexander Fleming
This chapter aims to provide tips and hints for the clinician in training to prepare effectively for a “time out” in research. The motivation to do so may be driven by interest in a particular field of research and the wish to add “experience in research” to the portfolio. Often, the latter is required to advance to the next position on the career ladder. For nonclinical researchers, the next career step may be to carry out a higher degree and the question “why spend time in research” will be redundant, but other questions concerning the research topic, choice of supervisor, and funding will be just as applicable.
Spending time in research gives one the chance to explore a research question thoroughly and add a completely different aspect to the clinical training path. The “time out” of clinical practice should culminate in completing a project, publishing a paper, and/or submitting a thesis. Furthermore, this time should give the basis for a lifelong understanding, if not continuation, of research.
Frequently, the clinician will not be aware how far he or she steps out of the comfort zone of clinical work by embarking on a full- or part-time research project.
The only way to prevent disappointment is to plan and prepare the proposed period in research—making it a very precious time in every sense. This chapter will address a number of points that are worthwhile considering beforehand.
4.1 Why Spend Time in Research?
A doctor in training contemplating spending time in research must have a good reason to do so, as clinical and research activities demand different frames of mind. The unfamiliarity of the world of research with its distinctive expectations and own ways of measuring success should not be underestimated. It is important to understand the inherent differences in work pattern between clinical and research work.
Also, it cannot be stressed enough that progress may be slow and unpredictable. There may be initial failure, which can put the enthusiastic but inexperienced researcher under a significant amount of strain.
Lastly, a major concern for clinical trainees may be that time in research and thus away from the clinic might result in a loss of practical skills (e.g., in the operating theater). In reality, a preset time away from clinical work of 1 or even 3 years will not make as much of a difference in the long run as often initially feared. However, the timing of the research period needs to be considered carefully. In some countries, such as the United Kingdom, academic training programs have been introduced and the overall period of training may be extended to ensure all training objectives are satisfied.
A final thought may be that spending time in research will make the trainee a better doctor. While in general exposure to research methodology will enhance critical thinking and thus further the practice of evidence-based medicine, the reality of conducting a research project will be largely unconnected to direct clinical practice. Of course, the future results of the conducted research project might contribute to the evidence important for that field of medicine. Furthermore, the clinician spending time in research will gain insight in the research process, leading to new knowledge. This appreciation will be invaluable at a later stage in the clinical career when the exposure to new products and new techniques requires constant critical appraisal.
4.2 What Is Different in Research?
Time at medical school, as the name suggests, is laid out to learn and accumulate facts and combination of facts, usually in descriptive sciences. In clinical attachments, students observe and absorb clinical experience. Basic sciences are touched on in broad terms, but not enough to allow the experience of deductive reasoning.
The medical student usually only gathers glances on how novel facts are being reached. The processes of formulating a hypothesis, designing an experiment, scrutinizing the methods, and collecting and analyzing data are not practiced in medical school.
During the first foundation years in the clinic, the young doctor, still not fully graduated, is challenged to follow the pace of clinical work. This usually demands alertness, good communication, and quick organization. Clinical work follows demands posed from the outside (i.e., the timetable of work on the wards, clinics, and theater sessions)—this starts when one sets foot into the hospital and finishes when leaving. Day to day, the clinician deals with the problems that are presented: patients who require decisions, treatment, and operations. These decisions have their own momentum and urgency, and, particularly in orthopedic surgery, are often solved with an immediately visible and appreciable result (e.g., a radiograph showing the fixation of a fracture). During clinical work, there may be busy times with a number of demands happening at once. An exception is the operating theater, as it provides a relative oasis of calm. This is a place for only one task and allows the required concentration for the surgery to be performed. In general, the clinical world requires quick attention to new patients and new problems. And usually the clinician is able to go home with the sense of having completed a satisfactory “day at the office.”
Research demands an entirely different mindset. The researcher starts by formulating the research question. In contrast to clinical life, the problem will not be presented by a patient, but will be actively sought out by the researcher. The research question will go beyond a problem posed by an individual patient and seeks to find a true answer to a given question. Guidance by the research supervisor with academic experience will be vital at this stage. Equally, the researcher will determine how to solve the problem and which methodology would serve best to reach a valid answer. The necessity of funding will be referred to in more detail later on. The researcher with a clinical background will learn to apply research techniques, which are usually unfamiliar, requiring practice (e.g., cell culture, microdissection).
The researcher will perform most of the technical work alone and will interpret the results. The day will be structured around access to the laboratory but in general the working day will be self-motivated. The supervisor will help with the time frame, but much of the organization and daily prioritization will be left to the researcher. Lastly, after a successful time in research, the trainee/investigator will need to present and publish the results.
The relative lack of a structured day will be unfamiliar for anybody coming from a clinical environment. In research, it is definitely not enough just “to show up.” While in the clinic each patient sets a mini-problem, the research project consists of facets that come together only at the end of a prolonged period of time and effort. There are days where results or progress are not tangible. As a side effect, each working day has an ill-defined end. For the motivated researcher, there is always more to do, leading to an entirely different stress from the surgical “adrenaline.” The day of the clinician resembles a series of sprints, whereas conducting a research project is more akin to running a marathon.
4.3 What Does a Clinician Bring to a Research Laboratory?
It should not be forgotten that the clinician will bring a number of points, views, and attributes to the team that will be very valuable. The clinician will be rigorous in looking for and understanding the clinical relevance of each project, and will help the team with communication of the clinical problem underlying the research question.
Furthermore, the limited time in research and the need to achieve results in this period can help to drive the chosen research project forward. The surgical mindset tends to select the best practical solution to a problem rather than getting lost in a myriad of theoretical considerations.
The discipline instilled in medical school and the long hours required for a clinical day will also benefit the time in research. Lastly, there are a number of projects where clinical experience or operative skills can be of direct use for the project, may it be experimental research with animals or clinical research with patients.
4.4 Spending Time in Research—the Right Decision?
4.4.1 Motivation and Expectations
Before considering a time in research, it will be very useful to be clear about the underlying motivation and expectation (Table 4.1). The motivation for each individual may encompass various aspects ranging from interest in the subject to advancing the career, all of them being valid points. However, it is worthwhile to think of alternatives: Interest in the subject does not necessarily require taking time out for research. Conversely, there are other ways to distinguish the career (e.g., doing a specialist fellowship, adding a master of business administration degree or law course, or spending time in a reputable unit abroad).
There will also be intermediate options of pursuing a research project that may not require taking time out. It may be possible to take part in a clinical research project, such as writing up a case series, in a unit that collects outcome data in a prospective manner.
Occasionally, a laboratory project in a well-set-up unit may only require the commitment of 1 or 2 days per week. However, both of these “intermediate options” will require a similar degree of preparations in order to be certain that these aims will have a good chance of being achieved at the end of the attachment.
Another option is a structured program such as a master of science degree, which will provide a teaching program and require the conclusion of a small project rather than an extensive piece of original work. Enrollment for a master of science degree may be more predictable than spending the time for a self-organized research project.
Motivation of a clinical trainee is often determined by the example set by a leading surgeon, physician, or researcher. The inspiration by an individual might lead to the wish to reach similar skills in the treatment of patients, surgical technique, or conducting research. Furthermore, the exposure to debate might lead to awareness of topical questions in the field and the wish to contribute to the solution. Such exposure to a research question is likely to lead to strong motivation.
Motivation fueled by interest and inspiration will be a good starting point for the endeavor of research. The junior clinician who has not been exposed to a scenario where such motivation can be gleaned from should make this the first point of preparation.
Advice
Attend regional or national meetings, watch debates between senior surgeons/physicians, and read the background of these topics. Does this hold your interest and lead to the wish to find a solution? Would you like seeing yourself contributing to the debate with new facts in a few years?
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