Tackling Research- Basic Issues and Considerations for the Radiology Resident
Put an academic radiologist and a general community radiologist in the same room and start a conversation on research and radiology residency. How do you think that conversation would go? I bet there would be bitter debate and sharp words (kind of like the recent Clinton/Trump run for the presidency!). In fact, it would likely be next to impossible to get them both to agree on the merits of radiology research.
The academic radiologist would point out the necessity of research to allow the resident to understand how to delve deeply into an area within radiology, really understand the mechanics of how discoveries are made, and to create and advance new areas of knowledge within our specialty. He would espouse the importance of statistically analyzing false positive and negative rates, roc curves, sensitivities, and specificities, tools that are invaluable to becoming a good radiologist. Additionally, he/she would also likely say that without an understanding of the mechanics of the research process, you can easily be mislead by marketing and headlines for new software, contrast agents, radiology hardware, etc. that may at best marginally displaying the truth of an imaging process or at worst can be entirely incorrect.
On the other hand, the community radiologist would say that if you understand the fundamentals, can read films well, and know how to manage patients appropriately than what is the point of doing research? Let others come up with new ways of interpreting films, creating protocols, or creating new contrast agents. Or in other words, “leave the research to the academics”. The community radiologist would also utter in the same breath that research is too time consuming and costly as well as incompatible with the day to day running of a revenue generating practice. Why bother?
So, given these diametrically opposite points of view, the big question becomes: to what extent should the radiology resident pursue research during residency? Should you make it into an all consuming process or should you relegate research to just satisfying the requirements of your residency program? Given the potential difficulties of making this decision for some residents, I am going to go through how to figure out for yourself whether you should follow the advice of the academic or community radiologist. In addition, if you go down the research pathway, I am going to give some sagely advice about how to find a research mentor and what makes the best research projects.
How Much Research Should I Pursue?
Ever read about Maslow’s Hierarchy of Needs? If not, I highly recommend you click on the previous Wikipedia link. Instead of the Maslow’s Hierarchy of Needs, now picture the Radiology Residency Hierarchy of Needs. At the base perhaps you would have reading lots of films, studying, and lectures. At the apex you would have radiology research. The reason why this point is so important: your own basic needs of a radiology residency must be satisfied before you really can tackle the research requirement. Therefore, some questions that you must answer prior to tackling a research project would be: Have you been studying enough, attending lectures, and learning the basics of radiology concepts? Are you performing well on your rotations? Do you have to concentrate on other issues such as the USMLE? In other words, the resident needs to first focus upon becoming a good radiologist and then his/her research. Without the essential elements of a good radiology residency preparation, the entire pyramid will collapse. Why do I make this statement? If the resident is concentrating so heavily on research instead of learning all the imaging modalities and vital skills during his/her residency program, he/she will find it very difficult to perform well during residency. You want to make sure that you know the general skills of the radiologist first and foremost. Furthermore, too much emphasis on research can potentially lead the resident to lose focus on other issues such as passing the core examination. So, make sure not to forget about the main reasons that you are doing your residency: to become a radiologist.
On the other hand, if you are able to dedicate time to research because you are comfortably able to divide your time appropriately, by all means go for it. The rewards are numerous from both a practical as well as academic standpoint. If you are interested in academic radiology, love to come up with innovative ideas, and enjoy writing publications, significant research becomes very important. Publishing several papers and abstracts during residency and fellowship can really help to get that first job if you are interested in pursuing an academic career.
Even in private practice, performing research during your residency shows that you take an interest in radiology. From a community radiology job market perspective (although the community radiologist may not want to admit it!), if you have two equal candidates, one who has accomplished much research and the other that has done none, I believe that most practices would choose to hire the former.
The bottom line- yes, research can be rewarding but make sure that it doesn’t interfere with your basic mission of becoming a radiologist!
How Do I Find A Research Mentor?
Most radiology programs have some attendings that are almost exclusively clinical and others that are more academic. I would recommend that you seek out those mentors/attending that have a decent amount of research experience. Although these clinical based attendings can be great teachers and mentors for learning radiology, they will likely not be as useful for the pursuit of really understanding how to do research. In fact, although they may express interest in helping you out with research, often times, they will not be able to instruct you with how to complete a project. So, unless you have already have lot of experience with radiology research, a more clinically based radiologist may not be the best choice for a radiology research mentor. There are a lot of radiology attendings out there that don’t really have a clue how to structure a research project. (not that it makes them bad radiologists!)
Although not always possible depending on the size and structure of your residency program, also try to find a mentor in an area/subspecialty of radiology that interests you. It is more likely going to help you out later on in your career when you completed a project in your area of interest.
Finally, try to find a mentor that meshes with your personality. In addition to the grunt work of research, part of the research process involves bouncing ideas off one another and brainstorming. If you feel you are not an equal participant in the process, interesting research can begin to seem more of a chore than a true passion. It shouldn’t be that way. Personality can become a significant issue.
What Makes The Best Research Projects?
My favorite research projects are those issues and problems that have constantly nagged at me or annoyed me over the years of practice that you have a hankering to solve. In addition, I love research projects that are in an area of true interest. These tend to be the best and most satisfying projects. I find that esoteric projects without real relevance do not really provide that spark to take the research to the next level. It also may dissuade the resident from pursuing other projects down the line.
I recommend that when you are involved in day to day readouts try to take notice of the issues that bother the attendings or questions that occur in the areas of interest that you really love. There are few things more satisfying than coming up with a question that you thought about and then figuring out how to solve it.
Radiology research is an excellent avenue for understanding the mechanics of what we do as radiologists. We rely upon many presumed facts for granted, whereas these facts may not be based on the best evidence available. Performing your own projects really allows the radiology resident to understand how to determine what information are truly facts and what information does not have a basis in science. This process thereby helps the resident to read and interpret studies, and critically determine the accuracy of the information we use to interpret images on a day to day basis.
Furthermore, delving into research by completing a project can be a very satisfying professional endeavor as well as can become a capstone on top of our radiology residency training. In fact, I find there are few things more satisfying than answering your own question for which body of literature did not provide an answer.
However, it is important to remember, you as a radiology resident, need to satisfy the basics of radiology residency first and foremost. Before making a final decision on whether or not to become involved in a project, consider if you really have the time and energy to pursue the project to its end. If a research project is very involved and time consuming, think twice about the project because your first priority should be to become a well trained radiologist. Radiology research can be rewarding, but only to the extent that you are first satisfying the basic requirements of radiology residency training.