Looking forward to residency: translational or clinical research??

[HarveyCushing]

I'm a MSII thinking about taking a year off to do research. Just some brief background about my research experience to help you know where I am coming from: in college I worked in a basic science lab for three years and I took a year off before med-school to work in another lab that did translational research. In med-school I have been working with a clinician on case studies. My question is this; looking at the big picture and when applying to residency, would I be better off looking at labs that do clinical research or that do translational research on my topic of interest?

One interest that I have for a project is neuro-oncology. So should I look for a lab that does clinical trials and studies, or a lab that does translational research in a mice/rat model? Ultimately I would like to go into academic medicine and hope that this year of research would prepare me for that as well as some more publications to my name. The closest I have come to clinical research is working on case studies and running some tests on human samples. So what is the level of involvement in clinical research compared to translational? As a MSIII, would I be able to offer much to the clinical research project? Translational research is quite intensive and time demanding, so I wonder if I would be more effective with publishing on a clinical project? There are so many variables to consider, but it seems a clinical project might be the better choice?

Also when applying to a residency, is it safe to assume that clinicians would appreciate clinical research more than translational? Even if the translational research is based on a clinical problem like brain tumors or peripheral neuropathy? I appreciate your help and look forward to your responses.

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[RxnMan]

I'm a MSII thinking about taking a year off to do research...My question is this; looking at the big picture and when applying to residency, would I be better off looking at labs that do clinical research or that do translational research on my topic of interest?

The PDs I've spoken to appreciate clinical research more than any other. To paraphrase one when he was looking at my CV: "It's good that your research focused on patients, instead of some protein"

...So what is the level of involvement in clinical research compared to translational?...

This doesn't make sense - the level of involvement is whatever you make it to be. If you're asking 'how much clinical experience do you need to do clinical research,' or, 'how good do your clinical skills need to be?,' well, I conducted my own clinical study when I was a MS1.

Clinical means working with humans. That's it.

...As a MSIII, would I be able to offer much to the clinical research project?...

No less than anyone else who is hard working and motivated.

...Also when applying to a residency, is it safe to assume that clinicians would appreciate clinical research more than translational?...

In general, probably. But doing something you're enthusiastic about is more important. What would you think would look better in an interview, going on about your exciting work in disease X and teaching the interviewer, or a one-second one-liner about this one project on patients Y where you...did...um,..well...oh, hey - how about them Broncos?

And what if you applied to a place that did work in neuropathy?

 

[HarveyCushing]

This doesn't make sense - the level of involvement is whatever you make it to be. If you're asking 'how much clinical experience do you need to do clinical research,' or, 'how good do your clinical skills need to be?,' well, I conducted my own clinical study when I was a MS1.

Clinical means working with humans. That's it.

Thank you for your post. In regard to the clinical research, I was referring more to the clinical skills needed to be useful to the research team. This is probably my fault, but whenever I hear about clinical research I think about these massive studies over 4-5 yrs supported by huge grants. That is my fault. I guess you are right RxnMan, if I have a true interest in the topic and I'm hard working that is all that will matter. The rest will hopefully fall into place.

 

[RxnMan]

Thank you for your post. In regard to the clinical research, I was referring more to the clinical skills needed to be useful to the research team. This is probably my fault, but whenever I hear about clinical research I think about these massive studies over 4-5 yrs supported by huge grants. That is my fault. I guess you are right RxnMan, if I have a true interest in the topic and I'm hard working that is all that will matter. The rest will hopefully fall into place.

If the study is worth anything, everyone involved will be trained on what to do and look for. Pilot studies, for example, not only search for proof of concept, but help train the team before the real deal takes place.

Don't think you have to do a huge 5-year study - you can, but I couldn't imagine the work involved!

I did a small study where I tested 20 subjects. My testing phase took place over about 8 months. It took me about a year to come up with the idea, the plan, the money, get the IRB approval. I've been analyzing the data over the last 7 months, but that's been drawn out by little things like Step 1 and 3rd year!

 

[HarveyCushing]

Bump for any other opinions. I really appreciated what RxnMan had to say. Curious if there are any other thoughts.

 

[Gabujabu]

As an M2, I'm doing a clinical study that involves getting the samples from 75+ patients taking a drug and then genotyping those samples. This required writing an IRB application, getting the pharmacists at a clinic involved, ordering kits, and arranging to have a company do the kind of genotyping assay I'm looking for. I'm about 6-7 months into the process and really enjoying it so far. I think it's definitely possible to get something substantial done in clinical research before rotations/residency, and especially if you take a year off. I don't think I would have been able to get much done with a mouse model and would have likely worked with a postdoc on a project that resulted in a middle-authorship if I was lucky. However, I haven't taken a year off to do research, and I'm sure that doing so would provide more time for a project like that.

 

[HarveyCushing]

Since I started this thread I have spoken to a few (4) academic physicians, several of whom play an active role in interviewing/ranking of residents. I heard both sides of the story. Some thought clinical research would be more valuable, and others bench work. One of them mentioned that when looking at past research experiences of potential residents the most important indicator is how productive they were with their research time. If they spent a year doing research, but only have one abstract or a 5th author paper to show for it, vs. an applicant who comes in with 4-5 papers of which one is a 1st author, he said it is clear to see who was more productive.

He then went on to say that in his opinion it is easier to be productive with bench research because you should be able to get at least one first author paper from a project that you worked on for one year along with several contributing authorships. Clinical research he said, and I guess he emphasized "good clinical research", takes much longer to do. Just to let you know this guy is at a top 5 NIH funded medical school. So in his opinion number of publications was the best indicator of productivity. I'm not sure I agree with that, but taking that into consideration is he right that translational/bench work would be the best route for productivity for a one year research fellowship?

 

[socmob]

That's interesting...everyone I know says that clinical research is definitely the fastest way to get published. So many opportunities for easily completed small survey studies or chart reviews...

 

[HarveyCushing]

That's interesting...everyone I know says that clinical research is definitely the fastest way to get published. So many opportunities for easily completed small survey studies or chart reviews...

Yeah that is what I thought as well. But I guess he put an emphasis on "good clinical" research. I guess you could also put that tag on "good translational/bench" research. I think maybe he was referring to prospective clinical studies as being "good" clinical research since those are the ones that get all the glory with clinical research. They also take a lot longer to complete obviously since you need to enroll enough patients to get good data.

 

[HarveyCushing]

I came across this other thread that might be useful if someone comes across this topic in the future wondering the same thing:

http://forums.studentdoctor.net/showthread.php?t=582487

 

[RxnMan]

So good thoughts all around. A couple of thoughts:

Yeah that is what I thought as well. But I guess he put an emphasis on "good clinical" research. I guess you could also put that tag on "good translational/bench" research. I think maybe he was referring to prospective clinical studies as being "good" clinical research since those are the ones that get all the glory with clinical research. They also take a lot longer to complete obviously since you need to enroll enough patients to get good data.

This is part of what I was talking about. When I was talking about my work above, I was talking about testing patients. And there are 4 different levels of clinical trials (cells, normals, sick folks, surveillance), and studies at different levels vary widely in the time to completion.

Any study that examines patients with a particular condition takes a long time because you have to find and successfully consent those patients. Complicate that with trying to get a good high n, and the finish line just gets further away.

That's interesting...everyone I know says that clinical research is definitely the fastest way to get published. So many opportunities for easily completed small survey studies or chart reviews...

Chart reviews and case reports are very easy to do because the hard part in clinical research - data collection - is already complete. The patients have already been seen. However, the questions are much less powerful* and more of "what methods worked the best in the past" and "who benefited the most from our treatments."

*Powerful refers to amount of scientific certainty

Since I started this thread...I'm not sure I agree with that, but taking that into consideration is he right that translational/bench work would be the best route for productivity for a one year research fellowship?

You've got a good opinion there, and I agree with him. Papers in general are the indicator of productivity. Posters and abstracts have a place in there, but if a project is good, you should be able to take it all the way to a paper.

My research plan, should I get into the NIH (see Cloisters thread) is several-fold.

1) Design one clinical project, from the ground-up, and carry it through to completion (hypothesis -> IRB ->...-> analysis -> pub). I don't want/expect Earth-shattering results, but I want to finish a small study in one year.
2) Between subject testing for #1, participate in several more basic-science/translational projects.
3) Get more clinical experience through the general fellowship program.

I am more than willing to change up subject matter (study syphillis [common condition] vs. Lesh-Nyhan [exotic but rare]) to accomplish 1 because I want to get the experience of fully running a study. It also means finding a lab with a bunch of small projects available. Finding a lab like this would take some luck, but the NIH has over 1000 protocols running...

Hopefully this will result in a 1st author and a few 2+ authorships. This plan fulfills the "means between the extremes" for residency. Some PD's have explicitly told me they like my CV because most kids have only worked with "some protein." Others want basic research stuff.

 

[Pinkertinkle]

It is my impression from talking to many professors that basic science research is more valued than clinical research when it comes to match.

 

[HarveyCushing]

It is my impression from talking to many professors that basic science research is more valued than clinical research when it comes to match.

I thought that PeepshowJohnny had some interesting comments in the other thread on the topic of clinical vs. basic science:

I'm going to disagree with some of your "pros" for basic science. While it's true that some of this stuff really CAN be high impact and more valuable, a lot of it isn't. I've lost count of the number of people who I've meet through undergrad on who told me about how their research on Alzheimer's/ Spinal cord regeneration/ obesity biochemistry/ and every type of cancer was really "Cutting edge, it's amazing stuff".

And what came of it? Nothing as far as I can tell. I mean, it can look really promising when you discover that protein AKQ3, a signal transduction moleculre, is upregulated in 63% of the rat models of breast cancer, but that doesn't necessarilly mean anything until it's put into practice.

However, just as you said basic science research is more interesting in your opinion, I tend to find most of it dull until it's put into a clinical picture. And honestly, you'll find program directors tend to be of either your or my persuasion.

The best of both worlds may be looking into if you have a department which focuses on translational research. I know the NIH was starting to endorse these types of endeavors a few years back. Basically, it's type of experiments bringing the bench to the bedside, so you can talk about some groundbreaking new monoclonal antibody, but also present what it did in patients.

While I am obviously not a PD, I think it is unfair to make a blanket statement that basic science research is held to be more valuable across the board for residency match. I think each PD will have a different opinion depending on their "bias" opinion. Both kinds of research have their place, and imho research of any kind is better than none when applying for residency, and publications of any kind are better than no publications. While it might be fascinating to find protein X,Y,Z's involvement in a disease, PSJ raises a good point that it really doesn't matter until it is put into the clinical context and shown to work in human subjects. I know a lot of projects have shown promise in mice/rats, but when taken to the clinical arena have been shown to be less than effective. One example being MgSO4 in neuronal ischemia. Works wonders in rat models, but the same can't be said of human subjects. Basically basic science will always be able to spit out more data than clinical research will know what to do with. The hard part is taking what basic science shows, and using that in clinical research. That is one reason why "translation research" is being heavily pushed by the NIH.

Pinkertinkle, I also believe a distinction needs to be made between retrospective and prospective clinical research. A prospective clinical study of statistical significance would be held in just as much light as any basic science project, if not more so imho.

 

[ellia08]

[shrugs]
There are 4 big things to weigh here:
####
1. what field do you want?
2. what skills do you have?
3. what do you like?
4. what do you want to do in the future (aka: what skills do you want)?
####

Re: 1 You probably know better than I what research Neuro-oncologist's like (if they HAVE a preference -- some fields do and some dont. It just depends what you want to match into.)
Re: 2 Your past work and skills might make one type of research more efficient than another. Again its kinda up to how good you think your basic or clinical research skills are.
Re: 3 Obviously if you think you will hate one type (either basic or clinical) than that would be a waste of your time.

Re: the important #4
HERE 's the big one for me. When you are an academic Neuro-oncologist or whatever field you want to match into:
What kind of research will you probably do? (make an educated guess) Or what kind would you want to do?

Residency apps are tough/important BUT the toughest time in your career in academic medicine will be transitioning from your clinical training into a faculty position (and the postdoc and K award in between). If you work now to find a good mentor and develop strong skills in what you LIKE than you will be in a much better place to find a good mentor down the road. (In the short term, it also makes a MUCH better story for your residency app if it actually ties into what you want to do.) If there was ever a time to refocus/explore its NOW when you are still a med student and not in your academic post doc after your clinical training. If you see yourself running clinical trials, than do that! If you want to rock out some crazy basic/translational science, than do that! Find some good mentors. Build your skills. Become a part of the network of people in the work you actually want to do. (this helps for residency too) Get a good mentor or two who can help you when AND AFTER you progress to residency. A close mentor now will help you later. The skillset you build now (if you do a good and thourough job) you can capitalize on later.

Spinning research for a residency app is relatively easy. What directors like is often just a matter of marketing (unless you are in one of the fields that has a strong bias.)

This is a major investment of your time. Use it to lay the groundwork not just for a residency but also for your career.
.