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md / phd student stuff

finding a good mentor: asking the right questions

As I (and many many others as well) have previously written, finding a supportive mentor is all about asking the right questions of both the prospective mentor as well as the mentor’s trainees.  As you are going through the process, think about these qualities that you may find desirable in a mentor:

  • accessibility: does the mentor have an open door and an approachable attitude?  is the mentor around or often away on trips/conferences?
  • empathy: does the mentor have insight into what the trainee is experiencing?
  • open-mindedness: does the mentor have respect for the trainee’s individuality, autonomy, working styles and career goals that may be different from mentor?
  • consistency: is the mentor reliable in action and principles?
  • patience: does the mentor understand that success can sometimes depend as much on luck as hard work?  does the mentor understand that people make mistakes and learn at their own rates?
  • honesty: does the mentor communicate truth–whether good or bad–about the trainee’s work, the world and the trainee’s chances out there
  • savvy: does the mentor have a sense (and communicates it) of the pragmatic aspects of career development?
  • loyal: does the mentor value the trainee’s contributions and support as well as defend the trainee from outsiders trying to take advantage of the trainee?

I have previously written at length about finding a good mentor for both the research and medical careers and what a good mentor can mean.  I harp on this point over and over again because good mentorship is key to kicking off a successful career.  So if you are looking at a prospective mentor, try to hone in on these qualities and when talking to the mentor’s trainees in private, specifically ask.  Better to find out sooner rather than later when it may be too late.

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who has a patent?!?!?!

Just like you want to know how many NIH grant the guy down the hall has, you’re probably also wondering if he has any patents.  While you toil away at the bench or in the clinic, this dude is probably raking in the dough from his patent on the little floaty things that hold eppendorf tubes in the hot water bath.  Do you want to find out?  Then go straight to the US patent office website and do a search!  This will take you to the advanced search page and just type in: IN/[LastName]-[Firstname] (for example: IN/doe-john) or you can leave the first name off (for example: IN/doe).  You might be shocked at what you find…

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md/phd residency interview experience

 Alright Andrew, you win. 

As an MD/PhD student residency interviews tend to take a unique twist as there is the very obvious 4-6 year old elephant in the room, which clearly differentiates us from other candidates who went straight through medical school.  Below are some questions/issues that came up during my residency interviews and those of some fellow mudphudders that I felt were particularly specific to being an MD/PhD student.  (Note that while these questions/issues may be more likely to come up if you are an MD/PhD student, they may be likely to come up as well for medical students who’ve taken a year or two to do research). 

  • The one issue that came up and I felt particularly annoyed about was how I would feel taking orders from people younger than me that may be more senior in the residency program.  I think I’ve written about this before, quite annoyed, in that this question quite frankly implies that MD/PhD students are all arrogant asses.
  • You will get questions about your research.  This should in theory be really easy address since much of graduate school is spent describing ones research for presentations and in articles.  Most questions will require a superficial but eloquent answer/explanation but you will occasionally get quite in-depth or more involved questions.  The most involved question was actually a very open ended one where an interviewer asked me to describe one project that I worked one from start to finish.  The impression I got was that they wanted background, methods, etc.  So I just slammed them with my thesis seminar.  I had given that talk so many times (from previous lab meetings) that even though I hadn’t given it for about a year, I had it memorized stone cold.  Just know your research backwards and forwards.  This isn’t really something that you practice the night before the interview (although you should), this is just something that will come over time with practicing this over and over again.  Sounds painful but remarkably similar to what I’m going through in residency right now…
  • You may be asked if you would want/willing to take time off during residency to do research.  This may be particularly important to some programs or residencies in general.  Know if this is the case and be prepared to respond as truthfully as possible because you will be held to your word.  If you don’t want to take more time off in the middle of residency, then you should explain why.  I’ve written about my personal opinion about research during residency before.  In short, I think it’s worthless for an MD/PhD student.  But you need to come up with your position and be able to eloquently explain/defend it. 
  • One question I often got was regarding how my phd research would be applicable to my chosen clinical field.   In short, it didn’t superficially but the benefits of graduate school go so much deeper.  I think I’ve written about this before in response to a reader’s question.  Read on to be reminded of my annoyance. 
  • You may occasionally get few comments on the quality of your publications.  Some good and some bad, meant to get a rise out of you.  Don’t fall for it and don’t take it personally.  You will spend/waste a good chunk of your scientific career having to defend your work against pointless criticism so get used to it.
  • You may be asked about how your lab experience might be beneficial to your time on the wards.  This is a freebie so be ready to nail it.  I personally took the approach that many lab experiences can be used to illustrate my capacity to handle the wards.  For example, working in a team at all levels from a newbie to being a leader, dealing with problem coworkers, thinking on your feet, bringing different people together to solve a common problem, etc.  If you are lucky enough to get this softball, make sure you knock it out of the park. 

Here are some questions posed to me by the reader who’s pushed me most into writing this post:   

  • Were you a prized possession?  Yes and no.  It really depended on who and where I was.  I think it definitely gives you an edge but then there some fields and some programs where everyone is a mudphudder so sometimes it doesn’t really seem to help much at all.   
  • Or perhaps treated with bemused disinterest by non-reseach/clinical-only faculty? Sometimes.  But in my opinion, it’s then on YOU, the interviewee, to find a connection between you and the interviewer that will spark an interesting debate.  Once again, you will spend a good portion of your scientific career trying to get people to be excited about your work (i.e. see the significance of it) for funding, if for no other reason.  And, interviews, if nothing else, are a test of your ability to engage your interviewers in a positive way.  When I found myself in a situation where a clinical faculty member didn’t know too much about my area of research or just wasn’t interested, I tried to find a way of communicating the significance of the work in the bigger picture and relating it to something the interviewer may have been interested in.
  • Were you ever challenged with specific questions about one of your publications or asked to give a formal presentation of your work (I know the latter has happened with people).  Yes–see above.
  • Also, did you consider any of those PSTP programs that combine research with residency? Yes, but you need to be careful to weigh the pros and cons of these programs.  Namely, the advantage of getting to post-doc level research sooner vs. the hit that you will obviously take to your clinical training. 

If anyone has anymore questions regarding the mudphudder experience in residency interviews or if you any particular insights you’d like to share, feel free to leave a comment.

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non-r01 nih grants for new investigators

So if you’re starting out as a new investigator, you’re probably not going to get an R01 grant right off the bat.  There are, however, many NIH grants that are specifically aimed at new investigators for career development as a stepping stone to future application for an R01. 

I have a few buddies who are going through this process now and applying for many of these.  For those of you who aren’t up to this point yet, it may be useful to get familiar with some of these grants–at least know what they are referring to.  You will hear these terms being thrown around a lot in conversation and more importantly, it won’t be too long before this will be useful information for you to know. 

Code Description
R03 NIH Small Grant Program

  • Provides limited funding for a short period of time to support a variety of types of projects, including: pilot or feasibility studies, collection of preliminary data, secondary analysis of existing data, small, self-contained research projects, development of new research technology, etc.
  • Limited to two years of funding
  • Direct costs generally up to $50,000 per year
  • Not renewable
  • Utilized by more than half of the NIH ICs
  • See parent FOA
R15 NIH Academic Research Enhancement Award (AREA)

  • Support small research projects in the biomedical and behavioral sciences conducted by students and faculty in health professional schools and other academic components that have not been major recipients of NIH research grant funds
  • Eligibility
  • Direct cost limited to $150,000 over entire project period
  • Project period limited to up to 3 years
  • All NIH ICs utilize except FIC an NCMHD
  • See parent FOA
R21 NIH Exploratory/Developmental Research Grant Award

  • Encourages new, exploratory and developmental research projects by providing support for the early stages of project development. Sometimes used for pilot and feasibility studies.
  • Limited to up to two years of funding
  • Combined budget for direct costs for the two year project period usually may not exceed $275,000.
  • No preliminary data is generally required
  • Most ICs utilize
  • See parent FOA
K01
Mentored Research Scientist Development Award (K01)
  • This omnibus NIH K01 program is supported by NHGRI, NIA, NIAAA, NIAID, NIAMS, NIBIB, NICHD, NIDCD, NIDDK, NIDA, NIEHS, NIMH, NINDS, NINR, NCCAM, NCRR, and ODS. The purpose of the K01 program is to provide support and “protected time” (3-5 years) for an intensive, supervised career development experience in the biomedical, behavioral, or clinical sciences leading to research independence. Awards are not renewable, nor are they transferable from one principal investigator to another.

The Bernard Osher Foundation/NCCAM CAM Practitioner Research Career Development Award (K01)

  • This program is supported by NCCAM. The purpose of this K01 is to provide research training support for CAM Practitioners with clinical doctorates, who have had limited opportunities for research training, but a strong desire to pursue a career in CAM research.

NCI Mentored Research Scientist Development Award to Promote Diversity (K01)

  • The NCI invites K01 applications from individuals representative of groups that have been shown to be underrepresented in health-related science, who have been recipients of an NIH Research Supplement to Promote Diversity Award, any NRSA (individual F31/F32 or institutional T32), or can demonstrate that they have been supported in a mentored capacity within any research grant equivalent to an NIH peer-reviewed research grant.

NIDDK Mentored Research Scientist Development Award (K01)

  • The NIDDK invites K01 applications from advanced postdoctoral and/or newly independent research scientists (usually with a Ph.D. degree) in biomedical or behavioral sciences who are pursuing careers in research areas supported by the NIDDK.

NINDS Career Development Award to Promote Diversity in Neuroscience Research (K01)

  • Supported by NINDS, the objective of this program is to promote diversity among faculty-level neuroscience investigators who are competitively funded to conduct independent research.

NINR Mentored Research Scientist Development Award for Underrepresented or Disadvantaged Investigators (K01)

  • The purpose of this NINR K01 is to encourage the development of qualified underrepresented or disadvantaged nurse scientists to become independent investigators in research settings.
K02
Independent Scientist Award (K02)
  • This omnibus NIH K02 program is supported by NHLBI, NIA, NIAAA, NIAID, NICHD, NIDCD, NIDCR, NIDA, NIEHS, NIMH, NINDS, and ODS. The K02 provides support for newly independent scientists who can demonstrate the need for a period of intensive research focus as a means of enhancing their research careers. The K02 is intended to foster the development of outstanding scientists and to enable them to expand their potential to make significant contributions to their field of research.

K08
Mentored Clinical Scientist Research Career Development Award (K08)
  • This omnibus NIH K08 program is supported by NCI, NEI, NHLBI, NIA, NIAAA, NIAID, NIAMS, NIBIB, NICHD, NIDCD, NIDCR, NIDDK, NIDA, NIEHS, NIGMS, NIMH, NINDS, NCCAM, and ODS. The K08 represents the continuation of a long-standing NIH program that provides support and “protected time” to individuals with a clinical doctoral degree for an intensive, supervised research career development experience in the fields of biomedical and behavioral research, including translational research. Individuals with a clinical doctoral degree interested in pursuing a career in patient-oriented research should refer to the NIH Mentored Patient-Oriented Research Career Development Award (K23).

NCI Mentored Clinical Scientist Research Career Development Award to Promote Diversity (K08)

  • This NCI-sponsored K08 award is specifically designed to promote career development of racially and ethnically diverse individuals who are underrepresented in health-related science and for those who are committed to a career in cancer health disparities, biomedical, behavioral or translational cancer research.
K22
K23
Mentored Patient-Oriented Research Career Development Award (K23)
  • This omnibus NIH K23 program is supported by NCI, NEI, NHLBI, NIA, NIAAA, NIAID, NIAMS, NIBIB, NICHD, NIDCD, NIDCR, NIDDK, NIDA, NIEHS, NIGMS, NIMH, NINDS, NINR, NCCAM, and ODS. The purpose of the K23 is to support the career development of investigators who have made a commitment to focus their research endeavors on patient-oriented research. Clinically trained professionals or individuals with a clinical degree who are interested in further career development in biomedical research that is not patient-oriented should refer to the Mentored Clinical Scientist Career Development Award (K08).

NCI Mentored Patient-Oriented Research Career Development Award to Promote Diversity (K23)

  • The NCI announce the availability of the K23 award for career development of ethnically and racially diverse individuals with a health professional doctoral degree from groups that have been shown to be underrepresented in health-related science.

If any of the readers have had experience with these grants or applying for them, please share your experience or any tips that you may have to offer in the comments…

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CRISP – the nih grant database

Be honest, you want to know what NIH grants the PI down the hall has.  Right?  Of course you do.  You want to know how good he’s got it and how that compares to your NIH funding situation.  Well, the completely open thing to do would be to ask but then you look nosey and the other PI might figure out your ulterior motive.  But you have another option: the CRISP database.

To quote from the CRISP website:

CRISP (Computer Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions. The database, maintained by the Office of Extramural Research at the National Institutes of Health, includes projects funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Health Care Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH). Users, including the public, can use the CRISP interface to search for scientific concepts, emerging trends and techniques, or identify specific projects and/or investigators.

So you can use this database to spy on any investigator’s NIH funding status.  But in all seriousness, the CRISP database can be a really useful tool if you are thinking of writing a grant or even starting a new project because you can see if someone is already funded to work on your project.  It can potentially save you a lot of time in not writing a grant that someone else already has (or at least give you an opportunity to sufficiently distinguish your own grant).  Moreover, by knowing who else is working on a similar project, you can either know who to contact for collaboration or help (if you need it) or in contrast, you’ll know who to hide your work from…

Addendum:

Thanks to the readers who pointed out that CRISP is no longer up and running.  But, for those of you who still have the morbid curiosity to see which cocksuckers have NIH funding while you languish away barely making ends-meet on foundation grants, there is the RePORT Expenditures and Results query tool at: http://projectreporter.nih.gov/reporter.cfm

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something new

  So one of the major struggles I face as an intern is learning a new system in a new hospital. This is on top of having to deal with the new patient care responsibility. My suspicion is that learning the new system is as hard if not harder than the mounds if patient care responsibility. I am actually surprised. As a medical studnt I remmber watchng interns even residents struggling to learn our system: online order entry, online patient records, even where the bathrooms are. And, I was always a little confused about why it was so hard for them. Of course, my years of experience at that hospital probably biased my view of the ease of doing everything. Now, I have been feeling the pain for the last two months.  And I’m finally realizing one of the major benefits to stating at your home institution for residency is that you know where everything is, you know how the computers (and programs) work and you know where the bathroms are (that’s so key).  This is such a huge beneft on terms of avoiding pain. However, this advantage only lasts for about a month or two and then everyone catches up to each other. So, as I kept telling myself, my pain (at least in this regard) will only last so long. On the other hand, there are so many advantages to going to a different institution. Most importatly, the opportunity to work with new people and to see new things, experiences which can only broaden one as an individual. I think this is actually quite huge. Not only with regards to my education but also because it shows other institutions later on (eg when time cone to apply for fellowship or a job) that I can be serious about moving and starting fesh somewhere else. The institution where I did medical school is the kind if place where people stay forever.  There were definitely times when I felt that I was going to be there for going on forever since I was there for graduate school as well. And, during residency interviews, I always got the question of why should they believe that I would ever leave to go to another institution.  I always found this to be a sort of weird question–why would I spend $500 on travel and lodging for a residency interview if I wasn’t serious about it?  But it just goes to show the mentality of program directors, etc–every little detail can be interpreted in one way or another.
  So now I’ve been here for 2 months. I was asked by a close friend recently, don’t you miss [insert hospital name] and my response was NO!  It was an amazing place and maybe I’ll go back there some day (if they’ll take me as well) but if I had stayed there, I’d be in such a rut. After two months here, I’m still learning new things about how to manage patients and how the hospital works every day. And all of it is in comparison/contrast to what I learned before.
  My point is that it was very hard to break out of my 8 year rut, but now that I’ve gone through the painful process of learning a new physician order entry system, electronic patient record, PACS, etc, breaking the rut feels incredibly rewarding. For those of you who have to make the same decision or something similar (medical school, graduate school, fellowship, etc), the prospect of leaving “the known” can be quite daunting but it can be terribly informative/useful in the long run. I’m the king of staying put in my rut so if I’m saying this, there’s gotta be something to it (at least in my head).

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laboratory interview questions for graduate students, post-docs and PIs

In the last post on the laboratory for graduate students, post-docs and PIs, I got into the basic approaches to the lab interview.  It appears that structured interviews, where every applicant is asked the same set of questions aimed at delving into the applicant’s abilities and personality, tend to produce the best results.  So how to prepare for the structured interview? 

If you are the interviewee: ideally you should just answer these questions honestly, on the spot in a very impromptu fashion (well, you should always answer questions honestly).  But sometimes these questions can catch you off guard and then you spend 10 minutes trying to remember what is a time when you had a conflict with a lab mate (at least an episode you can tell the interviewer about–leave out the fist fights).  So I’ve found that it can be really helpful to go over some sample questions before hand in order to jog my memory. 

If you are the interviewer: then you need to figure out what questions will be important in flushing out the applicants qualities, which you think are most important.

As I mentioned in the last post, with experience you will notice the same questions (in one shape or another) being recycled between interviews.  This is probably because these questions are good at bringing out the various qualities of applicants.  As a resource to you, below are some questions that I found in a pamphlet I got a while go, written for the Burroughs Wellcome Fund and Howard Hughes Medical Institute:

For evaluating experience and skills:

  • what is (are) your most significant accomplishment(s)
  • describe the part you played in conducting a specific project or implementing a new approach or technology in your lab
  • I see you have worked with [a specific technology or technique].  Tell me about its features and its benefits

For evaluating commitment and initiative:

  • why do you want to work in this lab?
  • where do you see yourself in 5 (or 10) years?
  • what kinds of projects do you want to do?  Why?
  • tell me how you stay current in your field?
  • describe a time when you were in charge of a project and what you feel you accomplished.
  • describe a project or situation in which you took initiative

For evaluating working and learning styles:

  • what motivates you to work?
  • would you rather work on several projects at a time or on one project?
  • do you learn better from books, hands-on experience or other people?
  • describe a time or project when you had to work as a part of a team?  What was the outcome of the team’s effort?
  • how would you feel about a leaving a project for a few hours to help someone else?
  • if you encountered a problem in lab, would you ask someone for help or would you try to deal with it yourself?
  • would it be a problem to work after hours or on the weekends, should the project need it?

For evaluating time management:

  • how do you prioritize your work?
  • how do you deal with multiple priorities competing for your time?

For evaluating decision making and problem solving:

  • what is the biggest challenge in your current job?  how are you dealing with it?
  • describe a time when you had to make a decision that resulted in unintended (or unexpected) consequences (either good or bad)?
  • describe a situation where you found it necessary to gather other opinions before you made a decision 

For evaluating interpersonal skills:

  • how important is it to you to be liked by your colleagues and why?
  • if you heard through the grapevine that someone didn’t care for you, what would you do, if anything?
  • describe a situation in which your work was criticized–how did you react to and address the situation?
  • name a scientist whom you like and respect.  What qualities do you like about this person?

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the laboratory interview for graduate students, post-docs and PIs

Whether you are interviewing others for a job or you, yourself are being interviewed for a job, it is not a bad idea to know what kinds of questions are asked and how.  In this post, let’s consider the general approaches that are taken in interviews.  I was browsing through the book At The Helm: A Laboratory Navigatorby Kathy Barker and found the following passage:

There are several styles of interviewing, some of which most P.I.s might find too manipulative and distasteful.  For example, stress interviewing subjects candidates to difficult and hostile questioning to test their reaction to thinking under stress.  Other techniques are more useful and can be incorporated in your interviewing protocol.  Behavioral interviewing assumes that, if you can really find out what happened in the past, you can predict the future.  Asking questions about how candidates dealt with a difficult project or with other people at a previous job can suggest how they will act in your lab, and these types of questions will probably form the basis for your interview.

Personality profiling attempts to define candidates’ underlying personality by analyzing their responses to questions about real or theoretical situations.  An example of this would be to ask, ‘Upon finding out that a close colleague had fudged data, would you approach the person or go directly to the P.I.?’

Another technique that is actually part of many postdoc interviews is the situational interview, when the candidate is placed in a situation that might actually be on the job.  Giving a seminar and having to field questions about one’s own experiments much as are done day to day, is an example of this.  Some P.I.s do give a test or request a demonstration of a technique from candidate technicians.

The only kind of interview that has had any consistent success in predicting performance in the workplace is the structured interview, in which all applicants are subjected to the same questions and are rated according to predetermined objective scoring (Gladwell 2000).  The questions should examine past or present behavior to try to define the candidate’s ability to do the job and to predict future performance in the lab. 

excerpted from  At The Helm: A Laboratory Navigatorby Kathy Barker, p. 88-90

In the course of interviews, though, you may use or experience (depending on which side of the interview you are on) any of these approaches.  In my experience, the stress testing has largely fallen out of favor as it usually turns applicants off and can result in interviewers losing a lot of good applicants for the job.  If you are the interviewer, consider what kinds of approaches (and in what situations) you will take.  If you are going for interviews, consider how you will react to these various approaches. 

In stress interviews I’ve found that questions are often based on fallacies or they are just illogical.  So, as the interviewee, you just have to pick out that fallacy or the breakdown in logic and calmly answer the question by addressing those weaknesses in the question.  When it comes to personality profiling, I’ve found that you just have to be yourself.  There often is no right or wrong answer to these questions so it’s best to just say what you would actually do.  With these types of questions, I sometimes will ask the interviewer what he/she would do.  With experience you may notice that most people seem to expect one particular answer to a specific question.  Whether you agree or not, it’s up to you to decide how that should impact your own opinion.  The situational interview can sometimes be “interesting”.  You are basically called upon to do your everyday activities but this time you’re being evaluated!  It’s weird, when you’re doing your everyday work, sometimes you just “do” but when you’re being watched there’s a greater component of “think” that’s included, which can throw you off of your rhythm.  So before you go on your interviews, try preparing by practicing some of your everyday activities (or at least those you would be expected to do on the new job) with the mindset that someone is watching you–i.e. really think through what you are doing rather than letting muscle memory take you through it. 

Finally, the only way to prepare for the structured interview is really to think about as many questions as possible that could be asked.  After you’ve conducted or been on a few interviews, it becomes pretty obvious that there are subset of questions (still a long list) that are often adapted in one way or another to every interview.  I will address these in the next post… 

That’s right–always keeping you hungry for more! HAHAHAHAHAHAHAHA!!!!!!

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MIT opencourseware

MIT OpenCourseWare (OCW) is a web-based publication of virtually all MIT course content. OCW is open and available to the world and is a permanent MIT activity. If you’re looking to supplement your class notes with extra material or if you’re looking to brush up on a specific subject, why not start here? Most classes give access to syllabi, class notes and examinations.

mitopencourseware-picture1

What is MIT OpenCourseWare?

MIT OpenCourseWare is a free publication of MIT course materials that reflects almost all the undergraduate and graduate subjects taught at MIT.

  • OCW is not an MIT education.
  • OCW does not grant degrees or certificates.
  • OCW does not provide access to MIT faculty.
  • Materials may not reflect entire content of the course.

How do I register to use MIT OpenCourseWare?
There is no registration or enrollment process because OCW is not a credit-bearing or degree-granting initiative.

Can I get a certificate?
No. MIT OpenCourseWare is a publication of the course materials that support the dynamic classroom interactions of an MIT education; it is not a degree-granting or credit-bearing initiative. However, you should work through the materials at your own pace, and in whatever manner you desire.

How do I find what courses are available? How do I search your site?
A site overview is available for MIT OpenCourseWare. You can also browse courses by department or use the advanced search to locate a specific course or topic.

High school students and educators should check out Highlights for High School.

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my limits

My opinion is more and more that the point of internship is to push us to our breaking points. And then a little more. I’m fairly convinced that it won’t stop even at the breaking point. I’ve already seen a few people hit that wall and it hasn’t been pretty. Especially since after all the tears, all the screaming, the work is still there to do. 

I don’t know, has anyone who has done this or is in it now, ever had the thought, “I’m only ONE person”? I have that thought like 50 times a day. Today it was like a thousand times. I tweeted today that I felt like I was gonna cry. The old school doctors are all about telling us residents how weak we are, etc. but the fact of the matter is the amount of work that needs to get done hasn’t decreased since the introduction of work hours, etc. In fact, it has probably increased. The expectation is just that now we’re expected to get it all done in a limited amount of time. And that’s it. Get it done. Don’t ask, don’t make excuses, just get it done. I got des-troyed today. A huge service, discharged 7, admitted 3. Plus anything that could go wrong did. Patients changing their minds about wanting to take their medications, patients who were doing great yesterday were feeling like crap today or having intractable pain. And of course I’m the one all the nurses come to.  Pages all fucking day. My favorite is the two-fer. That’s when two pages come in at the same time and the pager makes an especially high-pitched squeal. It’s good stuff the way that a rusty nail is good stuff to step on.  

I mean some of the stuff that comes my way is ridiculous. I was dealing with a patient who wanted to do harm to himself (without getting too specific) and received 3 pages from one nurse, each increasingly angrier than the last about giving an other stable patient something for gas. And then when I went to call back, I got a ton of attitude. I gotta tell you, on some level that hurts. I really think that the worst is when you kicked while you’re down. For me personally, that’s why I always try to be nice. You just never know when you’ll run into someone who is having a miserable day and that niceness will actually do some good. Attitude, meanness and being an asshole do not Mudphudder a happy camper make when he is getting crushed. But, what can I do?  It’s not my style to really retalliate or get into it so I just do my thing and hope that my work gets done. 

So back to my original point, I really think that each day things are made a little tougher than the previous day just to see if that’s what pushes me over the edge. I know that’s really paranoid sounding and I don’t believe it either but it sure feels that way. I got some help down the stretch today from some students on our service in getting things ready and together for evening rounds. And we just barely made it. Not only in time for evening rounds but also making it through evening rounds. After rounds I thanked the students (you gotta do that–they work so hard and you just can’t forget what it was like to be a med student) and I expressed how I felt that today our little team was very much like a rickety old boat held together by duct tape and with bubble gum plugging the leaks. We were seaworthy, but just barely, and we wouldn’t have made it without every single little contribution. It was close. Sometimes I wonder how one person can be expected to do everything in one day. Sometimes it can be ridiculous. But somehow it (usually) all gets done. 

I don’t know, maybe I’m just whining too much. I’m definitely learning a lot. Not so much through active effort (too little energy and time) but because I have to do the same crazy stuff so many freakin times that it’s hard to forget. I’ve actually started dreaming about my patients and discharging them. It’s so sad–I used to dream about other things. Right now I’ll just settle for some sleep. 

Well, now I can go and get some sleep. This weekend I work over saturday night, so I can at least sleep in tomorrow. Hopefully it won’t be too bad but it probably will be. Whatever, though. If I didn’t cry today, I won’t cry tomorrow either–probably because I won’t have the time to.

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response to a reader

A regular reader and commenter recently asked if the topic of a mudphudder’s PhD really matters toward the mudphudder’s residency and the long run in general. I apologize for the delayed response, but I’ve been getting slaughtered on the wards so I wanted to wait until I got some time off (now) to give you a thoughtful response.

Anyway, the short answer is, No. At least in my opinion. A lot of people assume that your field of research in graduate school does make a difference and there are even residency interviewers as well as more senior/important people who will argue with you that it does.
I am someone whose PhD topic did not obviously match with my residency field, without getting into too many specifics. There are also many mudphudders who do their PhDs in biochemistry, etc. So just because their chosen field of medicine doesn’t have to do with folded proteins, does that mean the PhD was a waste? Heck no. Let’s start with the very obvious fact that graduate school is meant to teach you how to become an independent investigator. That training is valuable to any field of medicine. As someone who has gone through graduate school–without quitting–you have demonstrated that you not only can survive but also thrive in the face of scientific/research adversity. Second, I would argue that you would be more of an asset to a field by bringing skills from a completely different background. Case in point, some of the best biologists I know have PhDs in physics. Some even were physics professors! Finally, you can always find a connection between things you learned in graduate school, if not your specific field of research, with what whatever field of medicine you want to go to.
In this regard, it’s really easy for mudphudders with translational research PhDs to apply into residences that are directly related to their research. However I sometimes wonder how many of these mudphudders actually go that route because it’s safe. Don’t get me wrong, most mudphudders I know seem to have a real love for what they’re doing but I really do wonder about that sometimes. I also wonder how many of these mudphudders didn’t let themselves explore other fields, just because their research matches so well with a field that they may have interest in.
Anyway, the short of it is that in my opinion, the topic of your phd research doesn’t make a huge difference on future career aspirations/ residency. The point of graduate school is to become a professional, independent researcher who can develop interesting questions and then answer them. If you can learn to do that, then your graduate school experience will be an asset to any field of medicine that you go into.

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nih grant codes – is k08 a grant or a type of submarine ?

How many times have you heard people talking about R01 grants or K22 grants and you’re like, “what the hell is he talking about?”  A lot for me.  Many years went by in medical and graduate school where I would hear people talking about these different NIH grants without any clue about what each grant was for.  Eventually I learned about some of them through just talking to people but then I recently discovered the internet and looked up this comprehensive table at the NIH website.  If you want to sound intelligent or be able to participate in conversations about the K02 independent scientist award, check out this site:

http://grants.nih.gov/grants/funding/ac_search_results.htm

Sooner or later if you stay in academia, you’re gonna have to get awfully familiar with these grants…

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an apt comparison

Where I spent four years of graduate school.

Where I spent four years of graduate school.

Not too long ago, someone happened onto the mudphudder blog by searching:

 

are med school and grad school the same

on ask.com. 

Are med school and grad school the same?  No.

Having been through both now, the best way I can put it is that medical school is like a four year jail sentence: you go in knowing you have to put in four years of hard time and along the way you take it up the ass occasionally.  Graduate school, on the other hand, is like solitary confinement: you’re wandering around in the dark, not knowing how much time has gone by or even what year it is, slowly losing your sanity until one day someone opens the door, you see the light and you’re out–smelly and a shell of your former self.  And you still have to take it up the ass occassionally.

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13 hours later…

And the first day of internship is done. Can’t complain–13 hours is not that bad even if I was hustling around the whole day. Picking up some thai food as a treat and then I’m going home. Thank you all again for the love that you have heaped on me in the last few days. I sincerely appreciate it.

Mudphudder out.

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the final countdown

So the regular readers of this blog probably thought this post was just going to be the video clip of “the Final Countdown” by Europe that I post every so often, but NO! it’s not!  :-)   So if you haven’t already flipped back to google, here we go.

my first page (non-official)

My other first page (non-official, from me to me)

Tomorrow I start internship.  Crazy.  I last wrote about my fear of totally messing up this thing and I appreciate your kind comments suggesting the contrary.  At this point, I just want to get in there and fire it up baby.  I’ve spent this weekend going in, rounding with the current team, writing orders, learning the system, etc.  I put in my first official order as a physician.  I called my first consult as a physician.  I did my first discharge summary as a physician.  I received my first page–well, my first official page from someone else–as a physician.  Even better, my first page was back to a number that wasn’t working.  That’s not a good sign.

But I’ll make one last comment on the craziness of this all.  As medical students we get to write orders occasionally–mostly in advanced rotations (e.g. sub-internships) but those orders are always cosigned.  So while you are always approaching the process as though you are the doctor, deep down inside you know that someone will (has to) be double checking you on any little thing that could affect the patient.  I suspect the next few weeks won’t be too much different as an intern but quite frankly, my senior residents won’t be able to double everything that will affect the patients’ well-being.  So it is with some (serious) thought and rethinking and re-rethinking and re-re-rethinking that I am putting orders in right now.  I hope and I suspect that I will build up my confidence with time and experience but for now, I’ll just have to be inefficiently careful to the extreme.  Patient wants tylenol?  Hmmmmmmmmmmmmmmmmmmmmm.  Hmmmmmmmmmmmmmmmmmm.  Is there any reason not to give this guy some tylenol?   Hmmmmmmmmmmmmmmmmmmmm.   Hmmmmmmmmmmmmmmmm.  You get the picture.  But I’m happy that this kind of thought process is not sustainable throughout residency so at some point, I’ll have to get faster. 

Anyway, the last couple of days has seemed cautiously do-able.  I’m always discovering some new, critical responsibility that the intern is responsible for on our service, so I hope that I don’t bring the service to a screeching halt tomorrow.  But we’ll see.  100% is all I can give.

Wish me luck (although most of you already have, so thanks again).

I’ll write to you from the other side.

Mudphudder out.

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md/phd students are assholes

Or so some people must think.  I still owe you all a post on the MD/PhD student experience of going through residency interviews but one aspect of my interviews came to mind today and I wanted to write about it in a separate post.  (For the non-medical readers, if you didn’t catch my rants on the residency interview process, here’s a previous post I wrote as background).  One question that I was asked at a number of places was, “do you think you will be able to take orders from a more senior resident who is younger than you?” 

And my response was: “No.  If I am older, then I MUST know more than anyone younger regardless of how many years of residency the other individual has been through or that I have no experience in residency.”

What the fuck?  (yeah I’m writing it out).  Is it just me or was the interviewer essentially asking me if I’m an arrogant asshole?  It was even worse when I’d get the same question from different interviewers at the same place.  And it wasn’t just directed at me (although you may be thinking that), because I’ve heard other MD/PhD students getting the same question. 

The interviewer follows up: “Because some MD/PhD students have a hard time taking orders from younger residents.”

Here’s some breaking news: there are assholes in every field and every sub-group of people.  Sure there are jerks amongst MD/PhD students, but there are also jerks amongst regular medical students and residents as well. 

There are medical students and residents who walk into labs for their research rotations and having done some PCR several years ago, think that they are much better than graduate students or post-docs.  These people ultimately not only alienate everyone around them but also fuck up other people’s experiments through contamination, etc.  Yup, research people know exactly what I’m talking about.  And guess what–these fuck-ups are not MD/PhD students.  Yes, there are assholes everywhere. 

Now, my assumption is that these interviewers have had bad experiences in the past, which is why they ask.  And yes, I’ve even known MD/PhD students who have told me in the past that it’s bullshit to take orders from residents who are several years younger, but they were in the minority in my experience, and even before hearing that I would’ve classified them as arrogant.  

However, as I described above, I and others I know have had bad experiences with arrogant medical students and residents in the lab but that doesn’t stop me from giving them the benefit of the doubt to begin with.  In all fairness, though, I will acknowledge that the distrust does run both ways–yeah research people, I’m looking at you.  I remember in our lab the graduate students used to have a serious distrust and unjustified dislike of medical students, residents and fellows who rotated through the lab.  But that wasn’t cool either.  So let’s just try to get along people! 

Anyway, to end in a helpful and non-ranting manner, I’ll say how I always answer this question:

We all choose different paths.  That I may be older than many of the residents I’ll be working with isn’t because I was wasting my time–but rather because I was pursuing my own career goals through graduate school and getting a PhD.  In that time though, these residents have accumulated far more medical knowledge and experience than I have so there is absolutely no reason why I would have a problem learning and taking orders from them. 

That’s reasonable, I think.

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what do you think?

Someone wound up on my blog by searching google for:

do thesis advisors have big egos

What do you think, Buddy?  HAHAHAHAHAHAHAHAHAHAHA!!!!!! ;-)

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career choice impacts your academic viability

What is the most consistent measure of academic viability?  Scientific accomplishment?  Enlightenment of fellow man?  Bettering mankind?  Not really.  In my experience the most consistent measure of the viability of ones academic career is funding/money.  When big-name scientists lose their funding, they get the boot.  When the dude who has never really accomplished much somehow gets his hands on several million dollars of funding, he becomes the star.  I’ve seen it happen.  It doesn’t quite seem right but I don’t think universities care, in general. 

I was listening to a story about a division head who is effectively being terminated because of the loss of major funding (and the inability to get more funding) and I couldn’t help but shake my head in sad acceptance.  “Sad” because the situation is obviously sad!  Moreover, I know this person’s work and it is good–like New England Journal of Medicine good.  And, “acceptance” because that’s academics for you.  Better to know the ground rules going in than be surprised.  Nothing surprises me anymore. 

Nonetheless, because this is a fact of academics, it is important to consider the fact that your career choice will impact the viability of your academic career.  As time goes on, our careers all become more differentiated but there is always opportunity for adapting our work strategy. 

So what am I talking about?  From the perspective of pure researchers, it is pretty straight forward I think (but correct me if I’m wrong).  Either get grant funding or get the fuck out of here.  My feeling is that the best way to maintain viability through constant grant support (besides the obvious: do quality work, do lots of it, and know the right people) is to be in a field that maximizes the ratio of funding opportunities to competitors seeking those funds.  And that’s a tough balance to strike because “hotter” fields, with many investigators, tend to suck up most of the funding dollars.  You think the NIDDK gives away most of it’s grant monies for research of irritable bowel syndrome?  Actually, I don’t know–that could be the case, but to illustrate my point, my guess would be most NIDDK research dollars go towards diabetes.  The field I did my PhD research in was really hot and also really competitive and cut throat.  As much as I’m always screaming that “I WAS ROBBED” when I get shitty reviews back on my manuscripts, a few of my reviews really did read like that reviewer just wanted to suppress our work.  But, then again there was tons of grant money for that area of research. 

What about clinicians in academics?  Here’s where it gets a little more complicated.  Academic physicians tend to fall into one of three categories: physicians, physician-scientists and physician-educators.  The one common denominator for job security to all three categories is the amount of revenue that the clinical practice brings into the department.  This is obviously applicable to the pure clinician who does not undertake much research or teach.  However, it is also applicable to physician-scientists and physician-educators because at the very least, if the money generated through research or teaching activities falls through, there is always the clinical practice to depend on until, for example, the next grant comes in.  Therefore, there will always be more academic job security for someone whose clinical field of practice generates more revenue than a clinician who doesn’t.  It’s a sad fact.  I’ve seen some junior faculty who are forced to near 100% clinical work in order to support their salaries (essentially guaranteeing the end of the research career) in comparison to some other physicians who can cover their whole salaries (even without grants!) by working 3 days per week.  That’s a big difference.  Moreover, for pure clinicians the clinical revenue from a full week’s work will significantly impact not only salary level but also promotions as well.  I’ve noticed this to be particularly hard on the general internist who practices in an academic center.  Deferring all discussions on the importance of the general internist for now, it has become a fact that these guys are some of the most underpaid physicians in this country.  Couple that with work in an academic setting and you have a recipe for failure waiting to happen.  Especially when these guys are compared side-by-side (in terms of revenue production) with colleagues in, for example, surgery.  The fact is that physicians practicing less lucrative fields in academics have to do something else (research, teach, etc) and that something else better generate some revenue or at least acclaim.  At the end of the day, it seems to me that we are essentially renting our faculty posts from the university (e.g. through grants, services or revenues generated).  And, in order to do what you want in academics, it is important to have some idea of how you can strike the balance between career, research, etc that will allow you to pay the rent.

I’ll end by saying I don’t think that tailoring your career or career path to one of high academic viability (lots of money) is how anyone should approach it.  I think first and foremost you have to do what you love and what you are passionate about.  But in my opinion, it is important to keep the reality of academics in mind too.  Academics is hardly the ivory tower that people imagine it as.  It should be approached strategically, with all aspects–the good and the bad–in mind, so that you can maximize the odds of being able to do what you love in the academic setting.

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it’s all about the administrators

It’s amazing what a big role administrators can play in academics.  From the administrator in the graduate program office to the departmental administrator who puts in grant applications, administrators can make your life easy or extremely difficult. 

In my experience, I can tell you that the administrators in our MD/PhD office and my graduate program as well as thesis lab were key in making my life easy.  During the course of medical/graduate school, there are a lot of situations that can potentially come up where it is useful to have someone who will take care of things for you, e.g. deal with the registrar, dean’s office, budget office, etc.  As non-administrators, we don’t know many of the tricks that can, for example, cut the time it takes to get a hold of the right person at the registrar’s office from an hour to 5 minutes.  Who here has called an administrative office, like the registrar, and not received an answer?  Leave a message and we’ll get back to you–beeeeeeeeep.  Not cool when you need something taken care of in the next hour or even today.  In these situations, it’s nice to have someone who knows the right person to call as well as the right internal number that is sure to be answered (yes, these numbers exist).  Over time I’ve come to learn a few of these tricks but am not nearly as proficient as some administrators I know.  (as a sidenote, next time you get sent to an answering machine inside your university–administrative office or even within the hospital–try hitting the number zero; sometimes that will direct you to a phone that will be answered!!!)

The same can be said about the administrator of our graduate program who was extremely helpful when I was getting everything together to fulfill my requirements for graduation as well as our lab administrator who had my back throughout graduate school and took care of lots of little things that made my life much easier.  In contrast I have heard horror stories about administrators in other programs who not only don’t do their work but actually make life harder (e.g. losing things, not filing things).  One person I know almost didn’t get to graduate from graduate school because the program administrator kept losing the requisite forms that needed and were filled out by the student.  That’s ridiculous!!!!  Another person didn’t get reimbursed for conference expenses for over a year.  Can you really afford to shell out over $1000 for a conference and not get reimbursed for over a year? 

I wish I could say that this nonsense stopped at graduate school but it never does.  A junior faculty member I know turned in a grant application two weeks before the university deadline only to find out that his administrator sat on it and forgot to turn it in.  When he asked her about it, she sent him to five different offices around the university looking for his grant application when he finally realized that it had not gone anywhere to begin with.  Are you serious about that?!?!?!!?  This was for a junior faculty member whose career depends on grants.  Unbelievable.

I guess my point is that administrators are an often overlooked part of our evaluation of new places we go for work.  Having more experience with an MD/PhD program, graduate school program and joining a lab, I can definitely attest to how important a good administrator can be during those times.  So, if you are going to be interviewing for an MD/PhD program, graduate school program or even for joining a lab, make sure you ask other students how good and supportive the administrators are.  It’ll be obvious from peoples’ reactions just how good or helpful the administrators are.  Just remember, these administrators are the people who are supposed to be helping you (at least, not hurting you) for a sizeable period during a critical point in your training.  It’s definitely something to consider.

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academicians are pussies

Here is a comment that was recently left on this blog:

You’re a total pussy and judging by the comments above, that’s the norm in academia.

There is no justice in the world and there are no other lives where people get their karmic reward. You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes.

HAHAHAHAHAHAHA!!!!!  Sounds like someone who (1) isn’t in academics and (2) wasn’t loved enough as a child. 

But, it raises an important issue related to academics–how far do you take a fight?  Do you walk away, take a stand or take the fight to others?  It depends.  There are times when you will have to take it up the ass because the alternate would come at too great a cost.  But there are also times when it is completely appropriate and worth it to follow this commenter’s philosophy. 

However, “You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes” is the fastest way to get kicked out of academics in my experience, which is why I am writing this post.  In my opinion, the hardest thing you will have to do in academics is when at some point you will have to hold back on the urge to tell an asshole where to get off.  One of the barriers to always speaking your mind is the fact that your career (especially early on–but really until you become a departmental chair it seems) is controlled by a small group of people who all know each, were med or grad school buddies, talk to each other and hire based on each others recommendations.  Which is why pissing off the wrong person can totally destroy a career.  Moreover, someone is always trying to stick it to you in academics.  Papers, authorship, reagents, call schedule, etc.  Sometimes you gotta take one.  It’s called being a “team player”–a buzz word in medicine, for sure.  Even a reputation as someone who is not a team player can hurt. 

My point is that I’ve known a number of people who have adopted the general approach of “You need to have the courage to tell people where to get off here and now, that’s the only way to beat the a-holes“.  They have either been kicked out of or nearly kicked out of medical school, graduate school, residency and fellowship.  None remain in academics.  Which is why my empiric evidence suggests to me that you gotta be careful when it comes to getting into major conflicts.  You can be as courageous as you want to be but if it costs you your academic career or even an extra year or two in training, will it be worth it then?  Everyone I know who has gone through this would say that it wasn’t worth it. I agree that sometimes it is worth it to throw down.  I’ve had to a number of times as well and while it wasn’t pretty, it was the right move to make at that point.  But those occasions were few and far between.  More often than not, I and everyone else I know have had to take it.

Some people may call that being a pussy.  I call it being careful, calculating and deliberate.   I also think telling off every asshole that gets in your way is a poor career move and usually makes you appear to be an asshole as well.  Finally, I would be wary of anyone who suggests this as a general approach to life in academics.  This is not meant as an offense to the commenter but is simply based on the outcomes I’ve seen. 

So what to do?  As I’ve tried to relay before, I think the key is to first and foremost avoid such situations if possible, which is why I’ve been writing about my experiences in order to give suggestions for how to do so.  Second, I think you always have to be calculating and deliberate in what actions you do take.  If you decide to fight, then make sure it’s worth it.  If it’s not worth it, then walk away.  In either case, you can’t take a general willy-nilly approach to every circumstance. 

I’ve put out my experience on this but if readers from any stage in academia want to share their thoughts, experiences, or suggestions in the comments, I’d love to hear them since I think this issue of when and how far to take a fight is an important one for an academic career.

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i changed my mind–gimme gimme gimme

One of my favorite things about academics is dealing with people who feel entitled to anything they want (in case you couldn’t tell, I’m being sarcastic). Not too long ago I wrote an entry about a research associate who had given up on a project because she couldn’t/wouldn’t take it any further so the PI of the project, who is a friend of mine, asked me to pick it up, since the project was headed down a path related to one of my specialties.

So I’ve been working on moving this project forward over the course of the last few months when I hear from my friend that this research associate has decided that she wants to take over the project again and, in fact, has been calling me useless behind my back to my friend the PI. So we set up a meeting for the three of us, and this research associate told me that she didn’t need me and that I was dead weight.

Let me stop right there. I, in general, don’t feel a great deal of entitlement. I don’t want or need anyone to be nice to me. BUT, I draw the line at total and complete disrespect from someone who has no lab experience and whose mess I’ve had to clean up for the last few months. Especially in front of the PI.

However, the PI in this case is someone whom I consider a close friend and someone I didn’t want to put in a bad situation, so I just sort of parried the accusations with a smile and soon excused myself for a meeting (related to this project, no less). Long story short: I have now dropped this project, four months of time and work further, back into the lap of this research associate, which really pisses me off because this was a sweet little project. But for the sake of not dragging out a protracted battle with someone in my friend’s lab, I gave it up. Just wasn’t worth it.

So what’s the lesson to be learned? I like to extract a learning point out of every shitty experience I have. In retrospect, I think there are several lessons that I’m taking away: (1) A good friend whom you can trust in academia is hard to come by and worth taking one up the ass for. I think with the experiences in academia that I have had and written about as well as your own, it should be pretty clear how important it is to have someone in your corner. If you have a friend in academics that you can trust, then do what you can to help them out when you are in a position to do so. Especially if you are in the sole position to do so. In this situation, what was I going to do—wait for the jerk to back off? Help your friends. Enough said. (2) This might sound bad but I think experiences like this (which are common) motivate self-protective strategies: when in a collaboration, it may be prudent to keep some element of secrecy until the very end when it’s time for everyone to put their cards on the table in order to maintain indispensability. In this case I was working with a friend so as I set things up (work, collaborations, direction), I was completely open about it. But I got bit on the ass by this other person. I suspect that if she didn’t know of the progress and didn’t have all of the information, she wouldn’t be as aggressive about snatching the responsibility for this project away. I don’t endorse this kind of approach with trusted friends and colleagues, with whom I think you have to be open, but the last few negative experiences I’ve had have convinced me of the “general” necessity to protect ones time investment from usurpers. And finally, (3) I’m gonna bank on karma and say that sometimes you just have to let assholes take the lead and shoot themselves in the foot. I’m sort of in a weird situation with this one because I won’t let my friend’s project get screwed over if I can help, so I’ll always be there if needed. But if that isn’t a confounding issue, I think when you are faced with arrogant ignoramuses who spew nonsense, sometimes it’s best to let them go ahead with their “brilliant” ideas. And while I wouldn’t necessarily count on cosmic justice—since I know a lot of morons who have succeeded by cheating others—at least it’s nice to know that it might be a possibility, however many lifetimes from now it may be.

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give it up

I’ve written before about authorship issues that I have experienced.  Getting papers snatched away or just plain and simple not being given any credit (where credit is due) can be painful but it is also a common thing.  Another issue I’ve alluded to is a situation when you have to recuse your authorship because you don’t agree with the work or the interpretations.  I’ve now had to do this twice.  I won’t get into the specifics of the situations (some which have already been described in previous posts) but while it hurt me both times to give up authorship (hey, I’m young and every paper counts here!), I don’t regret it. 

A similar situation recently happened to a friend of mine and he had to recuse himself from what would have been a nice publication on his CV.  Unfortunately, the people to whom this kind of scenario happens are often lower on the totem pole and therefore the people who would have most benefitted from the publication. 

We are recruited to participate in research project and we contribute valuable time and energy with an understanding of the goals/objectives that are being sought.  But what do you do if your results are interpreted in such a way that goes against both what you have previously published (thus making you look bad in print) and what you actually believe to be the truth?  None of us are ever recruited into a study knowing that this is going to happen or that the person with whom you are collaborating is going to pull a 180 so what are the options?  One possibility is proposing to do additional work (e.g. experiments) that would flush out whether one theory is more valid than the other.  Presumably, the fact that you are a collaborator indicates that your opinion is respected and therefore worthy of flushing out.  But that is not always the case.  Another option is trying to word the interpretation in a more objective fashion that reflects precisely what the results have shown, thus leaving open the possibility that both interpretations are possible.  Again, this depends on the fact that your opinion would be respected since you have supplied an necessary (and sometimes critical) part of the story.  And again, it is not always the case that your opinion is respected–just that your contribution is needed. 

My friend was needed to provide a service that only he could do.  He performed it and then was slapped in the face.  He didn’t know it was coming and tried working with his co-authors but ultimately gave up the fight and simply asked for removal from the authorship.  Instead he is now acknowledged.  And, better yet, his contribution is actually listed under someone else’s name in the “author’s contribution” section!  You gotta wonder what keeps people in academics sometimes.

The main issue with this is that neither I nor my friend nor young academics out there have the time to waste on a project that we will have recuse ourselves from because of dogmatic beliefs of a more senior collaborator.  However, we have to weigh this against the fact that collaborations are a necessary part of furthering our careers and they can even be really productive when it is a supportive relationship built on openness, communication and mutual respect.  (I better not getting any “dating help” hits from google).  So here are my suggestions, ask as many questions as you can think of to uncover any possible underlying agenda (philosophical, dogmatic, etc) when you are asked to collaborate on a project.  It is better to get it all out in the open than to spend your time on something that you ultimately won’t get anything out of anyway.  Moreover, it is a lot harder for people to go back on issues that have been discussed beforehand in contrast to issues that have never been broached.  Finally, if all else fails, you have to recuse yourself.  I write this mostly for the younger readers: it is NEVER worth it to put your name on something you don’t believe, regardless of where it’ll be published.  I’ve seen it ruin too many people.  And at the end of day, your scientific integrity is the only true and consistent predictor of the quality of your work.  Once you besmirch that, it’s all over–in both your own and others’ eyes.  I know it can be painful to give up publications and have to live with the fact that you contributed to a study that you don’t agree with but that is better than having to accept responsibility for that work (which is what authorship means, right?).  Moreover, look at each one of these instances as a learning experience that will inform you on finding productive collaborative relationships in the future.

And hopefully, my, my friend’s and other’s experiences will help prevent similar experiences for others in the future by offering some insight into how to approach collaborations as well as these situations when they arise.

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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.

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medical school to graduate school transition

One reader asked today:

I am a current MD/PhD student in my first year of med school. I am just curious about your thoughts on making the transition to grad school after 2nd year vs. after 3rd year. I lean toward going into grad school after 3rd year and am trying to convince my program that it would be better for me to do it that way. I would just like to hear an outside opinion!

I guess it would make sense that if I wrote about the graduate school to medical school transition, then I would have also written about the medical school to graduate school transition that mudphudders face.  I had sort of glossed over this because usually the medical school to graduate school is such a welcomed change of pace. 

As I have probably written before, the endless memorization of medical school “learning” can lead to significant rust in terms of ”thinking” so most mudphudders welcome the transition to graduate school.  One problem that can arise is referred to by this reader’s question.  Namely, when to break away from medical school to start graduate school.  I’ve known mudphudders who have started graduate school after the first, second, third and fourth years of medical school.  My recommendation is to either do it after the second or third years of medical school.  Second year of medical school tends to be pretty brutal at many institutions so having to come back to that from graduate school (i.e. if you left after the first year of medical school) can be a stone cold rude awakening.  Every mudphudder I know who has come back from graduate school to second year of medical school has found it to be an unpleasant experience.  The flip side is that there is complete continuity between the immense knowledge gained during second year into the clinical years.  But I’d still advise against it.  Doing the PhD after the fourth year should only be done if you have to do it that because of life-planning reasons, etc.  That’s not ideal for obvious reasons so I won’t get into it. 

So how to decide between starting graduate school after the second or third years of medical school?  Most mudphudders do it after the second year.  I think there’s a natural break there that lends itself to a smooth transition to graduate school: finish courses, may be do a couple of clinical rotations, take USMLE Step 1 (this is a MUST) and then hit graduate school.  I did it that way and I have no complaints.  Some mudphudders leave after the third year.  This is a little unconventional but definitely not unheard of.  The advantage of that is you get more clinical experience and hopefully figure out what field of medince you want to go into before you start the PhD.  And when you go back to the wards, you won’t have to scramble to figure that all out.  The mudphudders I know who started graduate school after the third year of medical school all wanted to gain more clinical experience and find their clinical passion before graduate school so that knowledge would inform what field they would study in graduate school and even what question to study for their dissertations.  I think that is a very valid reason for finishing third year of medical school before starting graduate school.  The disadvantage is mostly on the tail end of things.  When you go back to medical school after finishing the PhD, you will be a fourth year.  A lot is typically expected from a fourth year medical student so you will be under a lot more pressure to perform when you go back.  As a third year, it’s a lot easier to use the “I just came back from my PhD (i.e. I don’t remember jack)” card than it is as a fourth year.  Moreover, if you have sub-internships to do as a fourth year, that becomes even harder if your basic clerkship was 4 to 5 years ago.  Or if you managed to get the sub-internship done before starting graduate school, you will still have to do another sub-I to prove to the residency committees that you still got what it takes.  Either way, it will be more difficult than coming back as a third year.  But definitely not insurmountable as evidenced by the number of mudphudders who have successfully done it this way.  Also, after a few months back anyway, everyone is essentially accustomed to being on the wards.

The bottom line in deciding when to go start graduate school as a mudphudder will come down to how much clinical experience you need before graduate school.  I say “need” instead of “want” because this experience should be for a strategic reason–e.g. so you can tailor your PhD to a particular field.  If you can present a cogent argument in those terms for starting graduate school after any particular year (1st, 2nd or 3rd) of medical school, then your program should–in theory–have no problems with it.  It’s safest (in my opinion) to start after second year but think about your own needs/plans for the future and do what’s best and most strategic in that regard.

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md/phd students’ social life

I once met an md/phd student who looks like this

I once met an md/phd student who looks like this

I swear to God, some people must think md/phd students are pariahs.  Actually, there are a few who probably are–rightfully so.  Today someone ended up on this site by searching Google for the “social life of md/phd students”.  Probably a nervous incoming student.  Oh yes, I remember those days.  Faintly.  For the concerned students out there and for grossly misinformed, we md/phd students have plenty of time to socialize and socialize we do.  If you are a concerned incoming student, there’s nothing extra special in regards to time restrictions that an md/phd student faces compared to a medical student (when you are in medical school) or a graduate student (when you are in graduate school).  You will have plenty of time to do whatever you want.  In fact (now including the grossly misinformed), many md/phd students tend to lead some pretty interesting lives.  Not me, but many.

We have as much free time as we need.  The only thing is that the definition of free time is sort of unclear.  If I choose to involve myself in research projects such that I spend a substantial portion of my time writing, crunching numbers, etc., well that’s more of a choice than a requirement.  When I entered the md/phd program, I honestly didn’t feel like a dynamo–like I wanted to get involved in a bunch of projects.  I took it slow, mostly did intramural sports and hit the gym during first and second years for fun outside of school requirements.  With time, I just found interesting projects along the way that I wanted to get involved in.  But I still lead a fun and fulfilling personal life, doing things that I specifically make time for.  

If you are a worried incoming student, relax.  And if you are one of the grossly misinformed, then consider the fact that all types from complete dorks to professional athletes to famous musicians have gone through md/phd students.  I, unfortunately, am one of the dorks though.

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graduate school to medical school transition

Someone had asked in one of the recent comments about the painful graduate school to medical school transition that all mudphudders go through upon finishing the PhD, so I thought I’d write about that. 

First of all, I actually felt like the first two years of medical school had sapped intelligence from me so graduate school was a welcomed change.  The problem with medical school is that the “thinking” is mostly memorization and pattern recognition, not really any synthesis of ideas or problem solving per se.  In contrast, you could memorize like 5 equations in physics and in theory derive everything else from that.  No joke.  Remember F=ma?  Good stuff.  That’s what I used to do in college and before: memorize a few fundamentals and derive everything I needed from those.  Not so in medical school.  The only way to know the side effects of amiodarone (an anti-arrhythmic drug) is to memorize them.  But that’s the nature of practicing medicine.  It really does consist of a lot of pattern recognition so it’s all good.  And during the first two years of medical school, boy do you memorize a lot of patterns!  Especially during the second year.  I always felt that anyone who left second year of medical school, which for us was clinical in nature (e.g. pathophysiology and pharmacology), with everything memorized would make a really good intern.  When we started second year, we were told that our vocabulary would expand by 10,000 words during that year.  I believe it.  But I was a monster after those courses were over.  I even had the chance to do a couple of rotations, including my medicine clerkship, before I left for my PhD.  I’ll be honest with you, I was a stud on medicine because I easily memorized maybe 90% of our second year course work.  But then, medicine was over and I started graduate school.

Graduate school let me get back to that problem-solving mentality–”real thinking” I like to call it–which was refreshing.  The insides of my brain felt like the rusty gears of a pocket watch that had just been wound after two years of sitting on the dresser.  It felt good, at least after the initial shock.  And so I went for 4 years–problem solving and learning about immunology.  Without knowing it, slowly replacing most of the neuronal connections I had formed during the first two years of medical school.  Yup.  You can guess where this story is headed. 

I was always told by older mudphudders that my memory of all things clinical would come back to me after a few weeks back on the wards after finishing graduate school.  I don’t know, I guess that’s true.  I also think a lot of it came back because I read A LOT.  I think it was helpful that I restarted medical school with a pretty easy rotation–a family practice rotation where I was exposed to a lot of bread and butter medicine.  I also had a lot of time to read.  I think it hurt me in one way that I had taken my medicine clerkship before starting the PhD because I think the medicine clerkship is a great period of learning in a medical student’s training.  Although on the flipside, I think it gave me a good appreciation and understanding of medicine going into graduate school, which helped in other ways.  I think to this day I still feel a little self-conscious on the wards but performance-wise I think I have done well.  So maybe a lot of it tends to be in the mind of the mudphudder and we gotta just get over it. 

I knew a few mudphudders who would do clinical “activities” during graduate school.  Going to clinic once a week or month, etc.  I don’t think it really helped that much in terms of retaining knowledge.  I mean, you see 5 patients every week and that’s supposed to retain your 10,000 word vocabulary?  I don’t think so.  Moreover, think about the variety of clinical medicine we are exposed to in medical school.  Is one clinic going to cover all of that?  Most of that?  Half of that?  10% of that?  Probably not.  But at the same time, it keeps you in the loop somewhat.  My philosophy was always give 100% to graduate school when in graduate school and give 100% to medical school when in medical school.  But, I have friends who would argue against that as well so find what works for you or makes you happy. 

All in all, I think going from graduate school to medical school is not a bad transition.  I recall being ecstatic that I was done with graduate school.  But obviously when you’re away from something for that long, it takes some time and effort to regain the familiarity and knowledge.  Be smart and strategize about how you come back and to what rotation (which also means scheduling as far ahead of time as possible). 

In the end, it’s all a part of the process.  Medical school to graduate school to medical school to residency.  There’s pain associated with every transition but many have gone through it before you and many will after as well.  I think the key is in knowing yourself and therefore having the ability to identify what you need to keep you going in the context of whatever challenge (e.g. going back to medical school–> schedule an easy rotation so you have time to read) you are about to face. 

Anyway, I think that sounded pretty smart so I’ll end on that.

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invitrogen promotion

In case anyone could use it, Invitrogen is offering a promo until March 20th, 2009 where they will give you a $20 VISA gift card if you buy $450 worth of supplies from them online.  Our lab used to regularly drop tons of money with Invitrogen, so I figure that someone out there could use this. 

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mudphudder on the dr. anonymous blog talk radio this thursday

Hi everyone–I just wanted to put a plug out there…I’ll be on the Dr. Anonymous blog talk radio show this Thursday, March 12 to talk about Match Day 2009.  If you’re free, tune in and listen to us talk about the bane of my existence for the last eight months.

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does this sound kosher to you?

So I officially got screwed out of a publication today.  Many months ago I was approached by some people–friends and colleagues–about doing some work for a paper, which I eventually did over the winter holidays during my down time.  A couple of weeks ago they told me that someone else who works with one of their collaborators had done the same work I was asked to do but came up with a different result.  When they told me how the results differed, I realized this other person had made a mistake and told them why/how the mistake was made but that I couldn’t continue doing this work having to look over my shoulder and/or figure out mistakes made by this much less experienced person.  A couple weeks later now, I find out that these people–friends and colleagues–have decided to use the work by their collaborator’s person rather than my work. 

As a gesture, I was offered authorship on this paper although I have no idea how this other person did the work and my experience now is that this person’s work is suspect (with rookie mistakes).  So I turned down the authorship.  What choice did I have?  I can’t accept responsibility for work that I have no knowledge of and moreover think is suspect. 

I have mixed feelings right now.  The people who approached me and asked me to do this work are friends.  I don’t think they would purposefully ask someone else to also do the work.  At least I hope I wouldn’t get played like that.  I suspect they just got trapped in a situation with their collaborator.  But at the same time, I put in a lot of time to do this work–over my winter break no less–and I was rewarded with second-guessing and effectively a slap in the face.  It seems a little unprofessional to commit to me for this work and then burn me.  But again, these are people I’ve known for years and I have long considered them as friends so I don’t want to judge. 

What do you think?

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brain metastases are not good

Here’s an image below showing serial MRI slices through the brain of patient I saw today who was admitted to our hospital for several months of headache and recent onset weakness:

Each one of those little white dots (numbering over 20-30 in total) is a suspected brain metastasis (try clicking on the image to blow it up and make it clearer) from an unknown primary cancer that we’re hunting for right now.  Even if those white dots aren’t brain metastases (let’s hope so for the patient’s sake), as one attending physician commented this morning, nothing good could produce a brain MRI like that. 

Just another reminder to enjoy life and not sweat all of the daily bullshit we deal with–it could be much worse.

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