research during residency
So one of the biggest challenges facing a mudphudder is the prospect of putting aside all research for several (anywhere from three to five) years during residency training. Not that this is necessarily a bad thing–residency training is meant for producing competent physicians not researchers. But having actively participated in research for the last six to seven years (even now I have a couple of first author papers in press from work I did after I went back to medical school), it will be challenging to give it up at the level where I’m at now–think going from a two pack per day smoker to maybe a cigarette per day, if that.
This large gap in research activity can come at an obvious detriment to the scientist part of the “physician scientist”. When I go back to having substantial research time, science will be vastly different than it is now. Even since I’ve left the lab, the advances in my field of study have been astounding. So this three to five years away from the lab can have significant impact not only on eroding a mudphudder’s knowledge of the field but also on laboratory skills as well.
There are, however, a few options that can be pursued. One option consists of fast-track residency programs. These are basically abbreviated residencies in certain fields that allow the resident to jump to a fellowship (with research focus) sooner. I’ve mostly heard about this for internal medicine-based residencies where the first two years of the residency would be completed at which time the resident would go to a research fellowship in, for example, oncology or cardiology (as opposed to staying for the third and last year of the residency). I started thinking about all of this after I read what I think is an informative article about fast-track residencies in this week’s issue of Science. The problem with fast-tracking is that it is not really accessible to certain residency types, in particular surgical specialties. As it is, the eighty-hour work week is considered by many to have lead to abbreviated surgical residency training–forget about short-tracking.
In that case, many surgical residencies now offer (or mandate that) residents take one or two years off in the middle of residency to do full time research. This can be a nice fix for the mudphudder research junkies out there and is also helpful for the MDs who want an extended period of full time research experience.
Now for my opinion on all of this stuff. I like the concept of short-tracking in residencies where it is possible. However, there is no question that clinical training suffers from what I have heard. And to be quite honest, how can it not when you are only doing 66% of the residency (e.g. two out of three years in internal medicine)? I think in the Science article, one guy said that a downside of fast-tracking was that we wouldn’t be able to supervise junior residents (i.e. that he would be giving up his chief year). I can’t imagine how that wouldn’t impact a physician’s ability to lead a clinical team. But I think this is not as big of a concern for mudphudders who want to focus primarily on research careers. In fact, I think this is a good path for mudphudders who envision a career that will be mostly spent in the lab.
I am not as big of a fan of the other option–taking one or two years off in the middle of residency for full time research–for mudphudders. I think it’s a great opportunity for someone who hasn’t spent substantial time in the lab to take responsibility for a well thought-out project and take it to completion, in order to get a taste of real “research” but I think it’s a complete waste of time for mudphudders. One of the biggest challenges I faced when going back to the wards was giving up the momentum I had built up over four years in the lab–in another year I could have written another two basic science papers. But I gave it up for medical school training. And now what momentum I had is essentially gone. But I’m not regretful because studying for medical school is important too (I guess. Depends on which day you ask me). Anyway, in two years of lab work during residency, a mudphudder can build up momentum that will essentially be extinguished upon return to another two or three years of residency. Well, not completely–the lab the mudphudder worked in will build on that momentum–but not the mudphudder. Moreover, none of that work will like go with the mudphudder to fellowship or towards starting a lab–how could it?–the work would be three years old by then. In my opinion, I think mudphudders who can’t fast track just need to pound through the residency and pick up full time research again after it’s over. I think it’s a shame because a lot can happen in that many years away, which can dissuade a mudphudder from research, but I don’t think there is any other way to become competent in those clinical fields and use time efficiently. In cases where it is not possible to fast-track, I think the next instance of substantial research time should be during fellowship or a post-doc, to be done just before taking a faculty job so that research momentum can be harnessed towards producing results.
Everyone (e.g. residency directors and department chairs) want people who will go into academic medicine and become leaders in the field. But obviously, no one ever made it easy to go into academic medicine. And, the route is full of forks in the road, each of which could potentially add even more time to the training process (note I will be older than 35 when I get my first job), which isn’t necessarily a bad thing if the payoff is worth it. You just have to think about what is best for YOU and YOUR career, not people who may have a vested interest in whether you spend all three years in residency or take two years off to do research.