Contextualizing Research in Medical School
Research Roadmap
Ross Academic Research Society publishes the Research Roadmap series in order to help medical students with or without research experience become comfortable conducting research during their medical school career.
This article is the first of the series and aims to give introductory context to conducting, interpreting and applying research during medical school.
As a medical student, interpretation of research is important throughout your four years of education, but participation in research becomes relevant to career goals when in rotations and applying to residency programs.
Research in the Curriculum
Scientific research guides us to finding the answer to a question in a way that is reliable, replicable and ultimately, trustworthy. Naturally, scientific research underlies much of the foundational knowledge taught in medical school and plays into many different levels of clinical decision making. Conducting research drives medical innovation, interpreting research drives clinical understanding, and appropriate application of research drives better healthcare outcomes.
In medical school, curricular emphasis on conducting research varies. The Liaison Committee on Medical Education mandates that "a medical education program is conducted in an environment that [...] provides sufficient opportunities, encouragement, and support for medical student participation in the research and other scholarly activities of its faculty",(1) however, of the 147 US medical schools that responded to the LCME's Annual Medical School Questionnaire in 2017-18, only 44% indicated that they have a research requirement for medical students.(2) Further, what is considered a 'research requirement' is not defined. Even in comparing curricula from research-oriented medical schools like Columbia’s Vagelos College of Physicians and Surgeons and Johns Hopkins School of Medicine, there is no consistent approach.
Despite variable educational requirements, the medical community's dedication to research can be seen across a myriad of policies and guidelines. One of the most relevant to medical students is the National Board of Medical Examiner's United States Medical Licensing Examination Step 1 content outline, which lists 'Interpretation of the Medical Literature' as an entire subcategory, and includes topics on clinical decision making, interpretation and use of evidence-based data and recommendations, and research ethics.(3) In guiding medical education, the Association of American Medical Colleges lists "contribute to the creation, dissemination, application, and translation of new health care knowledge and practices" under the domain of 'Knowledge for Practice' in their Physician Competencies Reference Set.(4)
Research in Clinical Practice
In today's medical landscape, which values evidence-based medicine, scientific research forms the basis for algorithms and informs clinical decisions that you'll make everyday. But, is that research always trustworthy? The answer is, unfortunately, no.
Dr. John Ioannidis writes in his 2005 JAMA paper, which focused on analysis of findings of highly cited papers and compared them to findings in subsequent, similar papers, that, “contradicted and potentially exaggerated findings are not uncommon in the most visible and most influential original clinical research: 16% of the top-cited clinical research articles on postulated effective medical interventions that have been published within the last 15 years have been contradicted by subsequent clinical studies and another 16% have been found to have initially stronger effects than subsequent research."(5) Thus, as clinicians, the onus is on us to determine how rigorous a study was and how relevant it is to our practice.
A part of determining the clinical relevance of a study is understanding how that study was conducted. Medical research can be broken down into many categories of study, ranging from small-scale phase I interventional clinical trials that enroll tens to hundreds of patients in a single study, to large-scale meta-analyses that synthesize data collected from tens and sometimes hundreds of thousands of patients over decades.
Adapted from Röhrig et al, Types of study in medical research: part 3 of a series on evaluation of scientific publications, the above chart gives an overview of the types of studies that you'll encounter, broken down by category.(6)
Research on Residency Applications
As a medical student, interpretation of research is important throughout your four years of education, but participation in research becomes relevant to career goals when in rotations and applying to residency programs. Working in a research lab during a rotation can lead to networking opportunities and the potential for personalized letters of recommendation. The importance of demonstrated research experience on residency and fellowship applications fluctuates from specialty to specialty. It will be up to you to determine just how much research involvement will make you competitive without compromising other aspects of your application, such as your Step scores.
The National Resident Matching Program publishes two resources, for both Residency Match and Fellowship Match, that can help you gauge the investment in research in your specialty. The first is 'Charting Outcomes in the Match' which gives year-to-year statistics on applicants to programs by specialty. The second is the 'NRMP Program Director Survey', which gives Program Directors' responses by specialty to a question on how important research experience is to their program, rated on scale of 1 to 5, and gives the percentage of Program Directors who cited research experience as a factor in their decision-making for both offering interviews and for ranking applicants. As a student at Ross University School of Medicine, make sure that you're looking at the NRMP's statistics specific to US or Non-US IMGs, depending on your nationality.
Now that you have an idea of the relevance of research to your studies, your practice and your residency application it's time to look at the very first step of accomplishing any research goal: Accessing Medical Literature - coming soon!
References
01. Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Liaison Committee on Medical Education website. Published March 2020. Accessed October 27, 2020. https://lcme.org/publications/#Standards
02. Association of American Medical Colleges. Medical Student Research Requirement at US Medical Schools. Association of American Medical Colleges website. Accessed October 27, 2020. https://www.aamc.org/data-reports/curriculum-reports/interactive-data/medical-student-research-requirement-us-medical-schools
03. Federation of State Medical Boards of the United States and the National Board of Medical Examiners. USMLE Content Outline. United States Medical Licensing Examination website. Accessed October 27, 2020. https://www.usmle.org/pdfs/usmlecontentoutline.pdf
04. Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88(8):1088-1094. doi:10.1097/ACM.0b013e31829a3b2b
05. Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218-228. doi:10.1001/jama.294.2.218
06. Röhrig B, du Prel JB, Wachtlin D, Blettner M. Types of study in medical research: part 3 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2009;106(15):262-268. doi:10.3238/arztebl.2009.0262
Author
Kristin Ezell is a second year student at Ross University School of Medicine.
