By Trevor C. Hunt
This article originally appeared on Student Doctor Network on December 4, 2018.
Welcome to “Research for the Rest of Us”, a column about navigating the complex intricacies of life in the lab. These articles aren’t for the superhuman Nature-publishing, Nobel Prize-winning MD/PhDs out there, but rather for the rest of us: the Average Joes simply trying to get our feet wet in research. Join us as we journey through this complex world of academic adventures, from picking a project to matching into your dream residency and everything in between.
Research is a word that inspires a very narrow, stereotypical impression in the minds of those who hear it. A long white lab coat, beakers and pipettes, mice and rats, and for many, sheer boredom! That’s all there is to it, right? Just a bunch of esoteric experiments and monotonous measurements confined to a dingy, dirty corner of the life sciences building? Wrong! Research is much more, and the clichéd picture of it painted above is both wildly inaccurate and woefully incomplete.
There are countless exciting ways to get involved in research, and medical school is often the first place that students realize the diversity of projects out there. Sure, the lab bench is always an option, but did you know that simply writing up an interesting patient counts? What about penning a book chapter, or combing the EHR for lifesaving trends in the data, or even working with patients directly to test new medications and treatments?
Many students are turned away from research due to that antiquated stereotype of long days at the lab bench, associating research with tedium and dullness. This article will attempt to change that as we review the most common ways to do research in medical school, organized from most to least manageable. Those already considering research will be guided to the best opportunity, while those who dread the thought might just consider giving it a shot!
The Case Report
Case reports are a time-honored tradition in medical literature and are one of the easiest ways for students to get their feet wet in research. These publications generally include a detailed review of a single patient with a rare condition or an interesting disease presentation. A thorough review of the literature is also conducted and written up alongside the patient’s hospital course, to compare and contrast to any existing reports of similar cases.1 Finally, recommendations for treatment and management are advanced.
Pros of a case report revolve around simplicity. Finding an opportunity can be as easy as asking a mentor or lecturer if they have any interesting cases in mind that you could help to write up, or seeing a unique patient on the wards and suggesting the same to your attending. They are quicker to complete and shorter in word count than many other research papers, and can be worked on remotely since all you need is the EHR. This is often the easiest project for busy students to add on top of their studying, and including a classmate to split up the work is common. Finally, they are a great learning tool for the writer, allowing you to become an expert on the topic while having a lot of fun in the process.
Cons are minimal but important to consider. Namely, it’s common knowledge that case reports require less effort to put together and publish, so they carry less weight on your CV and ERAS application. All publications are not created equal, believe it or not! A case report will always add some value, but it won’t look as impressive as other types of research. Lastly, the lack of data collection may leave students seeking a more robust experience wanting more.
If you only plan to do one research project, you may want to consider something with a bit more rigor than writing up a case. However, if you are just starting in research or want to add something on top of other ongoing projects, a case report is an excellent choice.
The Chart Review
Chart reviews are more involved than case reports but share much of the same flexibility. Retrospective in nature, they involve mobilizing the EHR and its data to answer a patient-focused research question. Chart reviews examine aggregate data from hundreds of patients instead of a narrative from just one or two.2 As a result, they look more like a traditional research paper despite the fact that data is only being retrieved and not generated anew.
Pros of a chart review overlap somewhat with case reports. Both involve sifting through data that already exists rather than performing experiments. As a result, chart reviews are also some of the most manageable research projects for medical students. Sure, combing through hundreds or thousands of patient charts can be monotonous, but the freedom to do it while sipping a cool iced tea at the pool is hard to pass up! Chart reviews are also very easy to design when an important clinical question is raised, and their results can quickly change the way we practice medicine.
Cons, again, carry some overlap with case reports. Despite being a bit more robust, chart reviews are also known to be easier to complete and thus will not add as much to your CV as a more rigorous research paper might. Still, between a case report and a chart review, the latter definitely looks more impressive. Their retrospective nature can also be a challenge, as you might find your work stalling if you discover a need for more data that now cannot be gathered. Finally, that flexibility to work wherever and whenever can backfire, leaving you an afterthought to your mentor and making it harder to form a close relationship.
Overall, chart reviews are a great balance of investment and payoff. Students can reasonably juggle one or two on top of classes, and their retrospective nature means that work can be paused when it comes time to study for a big exam and resumed when free time is more abundant.
Clinical research is likely the most diverse and exciting discipline that medical students will encounter. This research happens right in the thick of it, collecting data from real patients in real time in the clinical setting. It can take on many forms; most commonly an intervention or treatment is applied and outcomes are tracked, but clinical research also encompasses survey data and anything else that directly enrolls patients.3 Often times these studies partner with large pharmaceutical or device companies; however, the academic medical centers where students reside will always have in-house projects running as well.
Pros of clinical research come primarily from the setting in which it’s conducted. The necessary patient contact is a great way to hone your skills, while the clinical environment puts you shoulder to shoulder with tons of physicians and is an excellent avenue for networking in your field of choice. Furthermore, these publications hit the sweet spot on your CV, adding a good bit of value due to the rigor required to complete them while also showing commitment to your chosen specialty if it happens to align.
Cons of clinical research are few and far between. Study design can necessitate a long duration in some cases, which might make it hard to publish the results prior to getting your ERAS application submitted. Additionally, the human nature of data collection might clash with your class schedule. These studies often require dropping everything to go see a new patient who meets inclusion criteria, and patients already enrolled may no-show for scheduled appointments.
If you can make the schedule work and don’t mind delayed gratification, clinical research is the Goldilocks of project types for many students. It’s the translational frontier where basic science meets the bedside, and is always ripe for medical student involvement!
Finally, we turn to the lab bench to address the quintessential project type: basic science. These projects are likely the first thing we all think of when somebody throws out the term “research”. They are the bedrock of scientific discovery, the experiments in which novel hypotheses are tested and retested to fight for minuscule advances in the field. Subjects are animals or cells rather than humans, and the results of these studies are what get printed in textbooks and guide clinical research efforts for years to come.3
Pros of basic science apply mostly to those seeking rigorous research training. Students who take on these challenging projects will be rewarded with an expertise in research methods and statistical analysis that few of their peers will ever achieve, while simultaneously learning enough about their topic to teach the class on it. Experiments are time-intensive, and the lab often becomes like a second family which all but necessitates a close bond with your mentor. Finally, the rigor and commitment required to publish in basic science is widely known, so these projects add a gold star to your CV. For example, a first author paper on mitochondria can add just as much weight as two or three simpler chart reviews might.
Cons of basic science generally align with the stereotypes we all know. Many students simply do not find it enjoyable, a sour taste left in their mouths from hours of monotonous pipetting as a pre-med. Basic science can be grueling and difficult, requiring a great deal of patience. Things go wrong, experiments need to be repeated, and techniques must be refined. On top of it all, the long experiments and rigid schedules of data collection make it especially hard stay involved in between medical school classes and clerkships.
Basic science is the epitome of research and will always remain as the backbone of science and medicine. Despite the rigors it necessitates and the intensity it demands, immense joy and reward can be found in its hard-fought victories for those students with the courage to dig their heels in.
With so many types of research out there, every student should be able to find a project that fits them like a glove. We’ve really only scratched the surface here, covering the most common projects a student might encounter. Many more exist, such as literature reviews, book chapters, epidemiological studies, meta-analyses, the list goes on. The variety is endless, and while the pros and cons vary from one to the next, all research experiences can be immensely valuable.
Wherever your interests lie, keep looking until you find the project that’s the best fit for you. And if you do somehow strike out or hit a brick wall, find a great mentor and start up a project of your own!
About the Author
Trevor C. Hunt is a rising fourth-year medical student and a member of his school’s Research Distinction Track, currently completing a one-year research fellowship. He authors the SDN column “Research for the Rest of Us”, using his experience to help others navigate the precarious pitfalls of life in the lab. He enjoys reading and art, and when not in the hospital or conducting experiments can often be found on a golf course or a ski slope. Find him on Twitter: @TrevorHunt_ECU
1. Gopikrishna V. A report on case reports. J Conserv Dent 2010;13(4):265-271.
2. Worster, A, Haines T. Advanced statistics: understanding medical record review (MRR) studies. Acad Emerg Med 2004;11(2):187-192.
3. Röhrig B, du Prel JB, Wachtlin D, Blettner M. Types of study in medical research: part 3 of a series on evaluation of scientific publications. Dtsch Arztebl Int. 2009;106(15):262-8.