Author + information
- Smita I. Negi, MD∗ ( and )
- Edward Koifman, MD
- Interventional Cardiology Section, MedStar Washington Hospital Center/Georgetown University, Washington, DC
- ↵∗Reprint requests and correspondence:
Dr. Smita I. Negi, Interventional Cardiology Section, MedStar Washington Hospital Center, Georgetown University, 110 Irving Street, NW Suite 4B1, Washington, DC 20010.
“The practical man is the adventurer, the investigator, the believer in research, the asker of questions; the man who refuses to believe that perfection has been attained…. It is always safe to assume, not that the old way is wrong, but that there may be a better way.”
—Henry R. Harrower (1)
Research is integral to any field of art or science. The cardiology community has been particularly active when it comes to research—basic, translational, clinical, or innovative. While contributing to rapid advances and new treatment strategies, research also has led to evidence-based guidelines, appropriate use criteria, and clinical practice statements among diverse specialties of medicine. Therefore, research is a mandatory part of adult cardiovascular medicine core cardiology training (2).
As physicians, we are obliged to pursue ways to improve management of our patients. A continuous pursuit for answers not only helps us become good clinical researchers and well-rounded clinicians, but can also improve the quality of medicine and affect patient care and outcomes, especially in light of the limitations of current knowledge (3). In reality, as fellows-in-training in cardiology, we are busy surviving calls and acquiring new procedural skills; therefore, staying involved in clinical research can seem like a daunting task (4).
Thus, here are some strategies we have found helpful in pursuing meaningful research during a clinical cardiology fellowship:
1. Manage time. We all have the same number of hours to work with, but how we plan our day makes some people more productive and efficient than others. Keep a day planner and allocate time for research during a work week. Another strategy that has helped some is to start the day early. Starting at least 1 to 2 h before clinical duties commence may give you some extra time each day to work on data collection or a pending manuscript. Make deadlines for projects and try to keep them. Targeting meetings for abstract submission can help you to finish projects on time and can help everyone who is involved stay interested and sufficiently motivated. Consider allocating extra time for research beyond the fellowship program. If you want to stay in an academic institution, this additional time will improve your research and academic skills and make your résumé more attractive when seeking an academic job. Should you consider going into private practice, this may be a rare opportunity to enhance your academic and research skills, such as understanding study designs, new technology evaluation, and data that contributed to guidelines. This knowledge will make you a better physician in the future, even if you will not conduct any research during the rest of your career.
2. Find a mentor. The importance of a supportive, resourceful research mentor cannot be overemphasized. It is of the utmost importance to find a mentor early in your fellowship who can help guide your research path. You can find a mentor in your own institution as well as outside of it. He or she can be an attending physician, senior fellow, cofellow, or even a resident or medical student. A good mentor can spark interest in research, can help define your career goals, and is crucial to research success in the short and long term (5). A good mentor is a role model, adviser, motivator, and critic of your work. You may obtain all of these benefits from 1 mentor or different things from different mentors. There is no limit to the number of mentors you can have. A good mentor/mentee relationship can also last a lifetime.
3. Be flexible. To be successful in research, it must become a way of life. Find the time to engage in questions and dilemmas that arise during any study. Think about these questions while driving to work, while working out, or by listening to a webinar on the subject. Discuss your ideas and progress over coffee or lunch with a cofellow or resident. This may provide opportunities for breakthroughs. Ask questions. Jot down research ideas that come to mind or any unanswered question during the attending teaching rounds, and ponder them when you can. You never know where you may strike gold.
4. Read. There are no short cuts to good research. Read all relevant literature on the topic in which you are engaged, even if you will not be involved in the investigation (6). Stay up to date in your field and relevant fields. Perform a thorough literature search pertaining to your area. Identify lacunae in knowledge. Try to examine how others have tackled a similar question in the past, as well as the limitations that they encountered. Keep up with the contemporary electronic and media skills.
5. Stay focused. Research, which can be long, tedious, and frustrating, requires consistent focus on the goals. There are obstacles to achieving research objectives, either at home or at work. Indeed, research requires cooperation in the workplace and support from family. It also requires focus on the part of the researcher. It is easy to be distracted from your path during the long course of research. To prevent losing sight of your goal, read your protocol often. Stay optimistic. Remember, nothing drains away energy and enthusiasm like criticism and pessimism. Set goals for the year ahead, and reassess and evaluate yourself at the end of each year.
6. Work in an area that interests you. Do not force yourself to work on something in which you have no interest, because you’ll likely get burned out (7). Pursuing a topic that you like will make it easy for you to work after hours and stay focused—the passion will drive you. In the end, what matters is the feeling of fulfillment, and this will be easy to achieve if you enjoy what you do. It is also very important to initially pick a project that is relatively achievable. Always engage yourself in 1 project that is easy and 1 that is more challenging.
7. Cooperate. No research task can be achieved without cooperation of cofellows, residents, medical students, nurses, and paramedical and administrative staff. Cofellows can help gather data and provide useful advice regarding issues encountered during the study. A researcher must be respected and liked to achieve cooperation from all involved. Similarly, collaboration can be important. An e-mail to a cardiology fellow who is working on a similar research question in a different program across the country or even on another continent may help swell the numbers in the study, provide new insights into your research question, and most importantly, lay the foundation for future collaboration.
8. Understand statistics. Statistics is a complex field and requires years of training. Fortunately, the statistics used in medical research is simple, and most statistical programs are user friendly (8). Even then, for the majority of us, statistics is a long-forgotten skill out of medical school, and our understanding is, at best, superficial. Alas, many physicians do not have statistical knowledge and, subsequently, wrongly interpret current research. Some may find it useful to enroll in a course, either classroom or online, on biostatistics. To conduct research, the understanding of statistical methods is important and, thankfully, is easily achieved through courses, books, and, of course, the Internet.
9. Go local. Every fellow hopes to present his or her research at national and international meetings. Unfortunately, not all research can make it big. Rejection of submitted research can be disheartening and can dampen enthusiasm. Local American College of Cardiology state chapter annual meetings can provide fellows a platform to showcase their research. Similarly, smaller section meetings also may serve as good targets for relevant research. Aim to convert all of your presented abstracts into papers. Nothing looks worse on a résumé than a long list of abstracts without resulting papers.
10. Participate in hospital quality improvement programs. Hospital quality improvement programs are an excellent opportunity to get involved in meaningful research. First, there are pre-existing research infrastructure and protocols already in place. Second, institutional review board approval is easier to obtain. Third, it provides quality improvement–related experience early in a trainee’s career, which can be very important in the long run. Special incentives, such as providing extra credits for involvement in quality improvement research by program directors during fellowship, may help attract fellows to this area (9).
11. Explore other avenues. Help your adviser and mentors with writing grant proposals, as it will help you hone your grant writing skills. Write for online newsletters and web pages when opportunities arise. Try to attend biostatistical and research-oriented boot camps for fellows during national conferences, or the American College of Cardiology’s annual “How to become a clinical investigator” conference.
12. Find uninterrupted time. Uninterrupted, protected time for research during fellowship may help a fellow see his or her project from conception to publication, leading to an enormous sense of satisfaction. However, because of work hour regulations, it is difficult to find a single 6-month block of research time during fellowship. Occasionally, you may be asked to cover for cofellows during this time. Nevertheless, allowing uninterrupted time for research, preferably, all in a single block or at least 2 consecutive months helps. Those who are set on a career in academics may require an additional year dedicated to research in a program with established infrastructure and resources. Alternatively, a trainee may pursue a 2 + 2 cardiology fellowship program. Consider writing a grant and obtaining financial support for an additional year if you are planning a career in academic cardiology. The experience accrued during this year may be critical for development into a clinician scientist (10). Cardiology programs should consider including formal training in research as part of the curriculum, with lectures during the 3-year period and an evaluation at the end.
In conclusion, there is no set path to success in research during cardiology fellowship; however, some of the previously mentioned strategies may help. At the end, remember, it is all about passion, focus, and fulfillment. Never lose sight of these and you will be successful, be it in research, clinical practice, or, for that matter, in life.
- Marc A. Pfeffer, MD, PhD ()
RESPONSE: Research—Enriching Your Journey
In preparing their commentary on research during a clinical cardiovascular fellowship, Drs. Negi and Koifman have already demonstrated that they can “take the plunge” from passive observers to active contributors to medical journals. As such, they have collaborated to identify a relevant issue, evaluated the literature, and put pen to paper to formulate and communicate their thoughts. Their commentary highlights some of the many reasons to incorporate some aspects of research into the already- demanding—at times, grueling—schedule of a clinical cardiology fellow. Of interest, the 12-point strategy they outlined to “facilitate an average cardiology fellow to pursue meaningful research” is, for the most part, excellent overall career advice.
In response, I offer congratulations to Drs. Negi and Koifman on making a thoughtful contribution. When submitting their final draft for publication, they undoubtedly experienced the 13th reason for expanding research opportunities to our fellows: the justified sense of accomplishment. As a minor criticism, the phrase in the title “walking the tight rope” is somewhat suggestive that there can be adverse consequences from a research experience. This comment is offered because learning to constructively use criticism is yet another reason to enhance the fellowship experience with exposure to research (strategy number 14). Rest assured, there is a reliable safety net in place, as research is not just for the “Flying Wallendas.”
How each fellow eventually balances the multiple privileges of patient care, education, and research in their long-term career is a highly individual matter. Whether or not research becomes a sustained major component of your professional career, having the exposure to investigation during fellowship enriches your journey.
The authors wish to thank Dr. Ron Waksman for help with content development and editorial guidance.
- American College of Cardiology Foundation
- ↵Great Thoughts Treasury: Thought-Provoking Quotations for Inspiration, Personal Growth and a Meaningful Life. Research. Available at: http://www.greatthoughtstreasury.com/research/quotes. Accessed December 19, 2014.
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