Resident research at community hospital

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geniusindisguise

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I'm a PGY-1 resident at a community program with a weak university affiliation. I understand that the best way for me to increase my chances of matching at an academic hem/onc program down the road, other than making connections with hem/onc people at academic institutions, is to be productive in research. Without the strong backing of an academic program, quality research may be difficult to conduct and so, I've been looking to pursue research methods that can be done without a solid support network and can be finished in sufficient time as to be able to produce publications before the match, for example, meta-analyses, literature reviews, and case reports. Are there any other types of research that can be done in a situation where support may be lacking?

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Those are probably the main ones - that and retrospective reviews if someone has the data laying around and hasn't found someone to analyze it. Though to be honest, you should see if there's anyone at your academic affiliate who would be interested in mentoring you. It is not that easy to just slap together a meta-analyses... ideally you would have some support/infrastructure to do a good job and have a collaborating biostatistician to oversee your work.
 
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Even in a community hospital, there are oncologists, and those oncologists will know someone at the university affiliate. If not, investigate the oncology faculty at the academic center, introduce yourself, and try hard to get onto a project (note though that a lot of attendings don't take PGY-1s seriously because of the workload, although you're about to be a resident so they will likely be more receptive).

As someone with >5 years of clinical research background and stats training, I can tell you that with no previous research experience you would still need someone to look over your methods and analysis for a meta. As mentioned above, simple retrospective analyses are likely possible (can throw together a quick univariate analysis and then fit a multivariate regression), but it's hard to get a single-center study published (most likely just an abstract or a poster at a regional conference).

You can definitely do case reports with onc faculty at your hospital, as case reports are simply descriptive (submit to SGIM or ACP). To get lit reviews accepted you will need an attending to be a coauthor (have never heard of residents getting review accepted solo). Bottom line, it is simply easier to find someone who knows what they are doing and sign-on or create a project with them, rather than bumbling into this on your own. Been there, done that.

Good luck!
 
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Thank you @HoldTheCoffee and @lulu09 for your advice. Looks like finding a mentor should be on the top of my priority list.

I do want to mention that I have some research experience including several first author pubs and a first author peer reviewed meta analysis pub which I took from start to finish (besides coming up with the research idea), so I'm familiar with the methodology and the statistics pertaining to a meta-analysis. Would it still be a bad idea to run a meta without a PI?

I also had a follow up question. Is there a feasible way to gain statistical training during residency? I know some programs have built-in clinical researcher MSc. programs that residents can undertake and some programs allow MPH at the home institution. If one's residency program don't have such luxuries what are some ways to gain structured stats learning?
 
You can run the idea by an attending and then go for it if you feel like you can handle it by yourself. In general though, unless you're some hotshot bigwig researcher I think there is commonly some bias against publications with a single author, much less a PGY-2. It's so easy to add names to the publication, so I would recommend that you still find an attending who is willing to sign on to your project and look over it.

And this gets to a point that I forgot earlier: the point of having a mentor is often so that you know how to ask the right questions. These attendings have been in practice and going to specialty-specific conferences way longer than you have, and know the hot topics and nuances of the field immensely better than you. Some attendings are literally gold mines for ideas but due to their age, clinical commitment, or lack of analytical/stat skills cannot carry out research projects themselves. I had some of my greatest success working with these older attendings who gave me great ideas for projects and allowed me to run with it (and obviously I am happy and grateful to include them as the PI as they came up with the original idea). This applies to any type of research, whether it be a case report, a lit review, or a prospective trial. Sure, anyone can go on Pubmed and see if some idea has been done before, but is it relevant to the ongoing discussion in the field?

For your second question, no there is no easy way. The most robust and structured way would be to tag on to a MSc/MPH program at your institution (likely after you graduate or start in your 3rd year if they have classes that don't conflict with your scheduled work -- I personally do have a masters that I did in medical school). You can learn by apprenticeship in residency by asking statisticians good questions and reading up on stats yourself (UCLA IDRE is an amazing website). There are many intro-level stat texts for clinical researchers and you can work your way through one of them to get a better understanding. Honestly, the biggest thing in stats is knowing what analyses to run and the assumptions associated with these analyses, which is both easy and hard to learn. Hard because if you don't know what you're supposed to learn, then you just never know unless someone tells you -- but easy too because once you know, you can do 80% of common analyses in medical literature solo without too much statistician oversight. I do all of my own analyses for my papers but I do run the final results by a statistician who then tweaks my analyses a bit to take into account certain assumptions...etc. or adjusts them to another, more obscure, model that might be more appropriate. Learning stats is kind of like snowboarding. It's really hard to pick up in the beginning, but once you have a firm base, the learning curve isn't incredibly steep for the purposes of medical research (I am always shocked at how little general attendings/clinicians know about stats even though everyone tries to pretend at journal club).
 
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You can run the idea by an attending and then go for it if you feel like you can handle it by yourself. In general though, unless you're some hotshot bigwig researcher I think there is commonly some bias against publications with a single author, much less a PGY-2. It's so easy to add names to the publication, so I would recommend that you still find an attending who is willing to sign on to your project and look over it.

And this gets to a point that I forgot earlier: the point of having a mentor is often so that you know how to ask the right questions. These attendings have been in practice and going to specialty-specific conferences way longer than you have, and know the hot topics and nuances of the field immensely better than you. Some attendings are literally gold mines for ideas but due to their age, clinical commitment, or lack of analytical/stat skills cannot carry out research projects themselves. I had some of my greatest success working with these older attendings who gave me great ideas for projects and allowed me to run with it (and obviously I am happy and grateful to include them as the PI as they came up with the original idea). This applies to any type of research, whether it be a case report, a lit review, or a prospective trial. Sure, anyone can go on Pubmed and see if some idea has been done before, but is it relevant to the ongoing discussion in the field?

For your second question, no there is no easy way. The most robust and structured way would be to tag on to a MSc/MPH program at your institution (likely after you graduate or start in your 3rd year if they have classes that don't conflict with your scheduled work -- I personally do have a masters that I did in medical school). You can learn by apprenticeship in residency by asking statisticians good questions and reading up on stats yourself (UCLA IDRE is an amazing website). There are many intro-level stat texts for clinical researchers and you can work your way through one of them to get a better understanding. Honestly, the biggest thing in stats is knowing what analyses to run and the assumptions associated with these analyses, which is both easy and hard to learn. Hard because if you don't know what you're supposed to learn, then you just never know unless someone tells you -- but easy too because once you know, you can do 80% of common analyses in medical literature solo without too much statistician oversight. I do all of my own analyses for my papers but I do run the final results by a statistician who then tweaks my analyses a bit to take into account certain assumptions...etc. or adjusts them to another, more obscure, model that might be more appropriate. Learning stats is kind of like snowboarding. It's really hard to pick up in the beginning, but once you have a firm base, the learning curve isn't incredibly steep for the purposes of medical research (I am always shocked at how little general attendings/clinicians know about stats even though everyone tries to pretend at journal club).

Thank you for this insightful comment. Im more of a skiier myself but I see what youre saying :)
 
I agree with lulu09 - sounds like you could probably handle or do a lot of the statistics yourself, but it would be a bit unusual to proceed alone and get published in a reputable journal without a little bit of back-up, not to mention the other clinical nuances you would miss without an experienced clinical PI.

Good luck! You sound very motivated
 
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