Research is central to advancements in how we practice medicine. Most of the notable advancements in health care originate from curious investigation. Research stimulates novel ideas, and innovative solutions. Research experience helps doctors to critically appraise new information.
Despite the benefits of research, our cynical approach to it is a deterrent to discovery and innovation in medicine. One way this is evident in medical training is the commoditisation of research into a tool that is used to rank higher in post graduate training interviews or get more grants, or attain prestige. This culminates in a culture that values research quantity over quality. For trainees, the more your research output the more points scored in job interviews.
The ability to take a research project from an idea to a publication or presentation can be used as a surrogate for a trainee’s level of commitment, ability to complete tasks and resourcefulness. However, once a research project is translated to a line on a CV in the form of an aforementioned endpoint, it is difficult to ascertain how much work really went into it. One can hardly differentiate a project with repurposed content from one that was done from scratch.
In addition people find ways to exploit the system to prop up their numbers and get the maximum return for their effort. Cynicism eventually sets in, hampering the quality of published research. Many trainees who might have pursued impactful projects, pivot to projects that are easier to publish than those that would actually solve difficult problems. Projects that answer tough questions often take too long to carry out. Spending too long on any given project does not ‘help’ their ‘research output’. Quite often, there is no recognition for the hours you spend Western blotting if your research wasn’t published.
Unfortunately, this approach to research is not limited to trainees and medical students. It seems to be pervasive in academia. The difference is the stakes change from getting a training posts to financial grants/reward and research prestige. This pressure on researchers is one of the reasons why many published claims are false .
How can we combat cynicism in medical research?
- Allocated Research time for trainees
- In-depth evaluation of research at interviews
- Not making research a requirement
Allocated research time for trainees
There needs to be a shift away for volume and towards better quality high value research that drives change. One way to encourage high value research is to allocate protected time as part of their training, to those who are interested in research. Lack of time is often a limitation to participating in research. Enabling trainees time to pursue genuine research interests will likely translate to more impactful projects.
In-depth evaluation of research at interviews
For post-graduate training allocation, many training bodies adopt a points based system. The more publications/presentations, the more points allocated. This approach fails to recognised different types of research projects and does not truly analyse the quality of work published. It drives trainees to churn out ‘easy’ papers and repurpose projects to increase their numbers. Perhaps we need to revise how we allocate points for research. We need more detailed evaluation of research carried out in order to reward research effort more accurately.
Not everyone should have to do research
Auditing clinical practice and outcomes is essential to maintaining standards as a clinician. Research experience is essential to understanding how the process works. Some have said all doctors should be involved in research for reasons that include being able to critically appraise medical information. All doctors need to be able to critically appraise medical information but it does not follow that all doctors need to be involved in research. Critical appraisal of research studies can be learned as part of a research methods module. People who want to explore or have a genuine interest in research should be encouraged. But expecting research from everyone likely contributes to the culture of research cynicism.
To effectively combat cynicism in medical research, we need to align our research practice with the true purpose of research. That is, to answer questions and contribute new knowledge. If our research is not doing that, then it is time to revise our approach.
A New York Times op-ed called for more doctors to be scientists. To succeed as a physician scientist, it involves answering difficult questions that often arise in clinical practice. Taking to the lab to answer such questions involves an arduous process of trial and error that often goes unrecognised. However it is in this process that revolutionary discoveries are made. A cynical approach does not value this. If we do not challenge the pervading cynical approach to research, medicine will lose its true scientists.
