What did I do during M1 summer?

The summer is coming to a close and M2 starts next week.  Over the summer, I went on vacation to the Caribbean, which was a very relaxing time.  I went jet skiing, swimming, sat by the pool, went kayaking, ate a lot and slept a lot.  I left for the islands just after school ended, and it was one great week.  After returning, I had one week to get my things together again to move back to school, as I was about to start a summer research project with my medical school.

During this project, I would collect data some days at a clinic, and then do some reading, data entry, etc on my own time.  In addition, I had plenty of time to watch a whole bunch of movies, catch up on TV shows, and sleep some more.  I didnt do any studying for a good part of the summer.  I would drive up to see my family and friends almost every weekend.  I even went on a mini-vacation to Dallas for a couple of days to meet with friends and spend time with family.  But, for the most part, I spent it just relaxing and working on the research project.

I did start studying a little during the middle of the summer.  I would read a chapter in my biochem lippincotts book, or in the big Costanzo Physiology book.  I would make some flashcards of things that I found hard to remember, so that I have them ready if I ever needed them for M2 year.  I studied Behavioral Science from the BRS series, as this subject was taught all over the place during my M1 year, and wasn’t very cohesive.

I made a list of books (and bought some of them) for my “Step 1 box” in which I store the materials I’m going to use to study for boards.  I read up on the actual exam, what’s involved, and also looked through First Aid for the USMLE Step 1 book, to get an idea of the depth of material.  This usually keeps me on my feet and emphasizes the amount of work I will need to put into M2 year to learn the material.

Currently I’m in the process of moving to my new apartment.  The summer has been great for the most part, especially because I just took it easy.  I’m slowly getting into the mental state for next year.

Administering the survey

After the IRB application, training, approval, and pre-research preparation (see previous post) has been completed, it comes time to collect data.

This involved, for me, sitting at a desk in a clinic waiting room, with a small sign that encourages volunteers to approach my desk.  When someone does stop by, I would briefly introduce myself and the project to them, then hand them an informed-consent form and a survey.  Most people took about 5 minutes to complete it, and the majority were enthusiastic about filling out the survey.  Occasionally, people would frown and walk away.

The hardest part is to get people interested in your project and approach the desk.  The staff members in the department I was working were supposed to suggest to their patients to visit my desk and fill out a survey.  However, it doesn’t always go according to plan – those staff members become extremely busy, and patients don’t approach you.  My project did not involve any type of remuneration for participants as I did not have funding of that magnitude.  This made it exceptionally hard to attract people to your project.

Imagine walking into a clinic for an appointment – you are worried about your health, you are worried whether or not insurance will cover the visit (or the results of the visit), you have taken time off from work/school to make this doctor’s appointment happen.  The last thing on your mind would be to find out what that person is doing at the extra desk in the waiting room, let alone help with the survey project.  So, for those who did approach me (the minority of the participants), I am thankful.

For the rest, although I am still thankful, it came with a little bit of effort.  I had to strike up a conversation with those sitting closest to me, waiting to see a doctor.  I would try to steer the dialogue to favor their interest in my purpose in the waiting room.  This is how I would get the majority of participants – make small talk with them, establish rapport, give them a little background information about myself, and request five minutes of their precious time.

Collecting data is one thing, but analyzing them is the interesting part of the project – its what all scientists are most interested in – What are the results? How can we synthesize our findings into the current working body of knowledge? To what extent will these results be useful, and to what end?

I’m a couple of weeks away from starting my analysis, and will write about that experience as well, when the time comes.

Preparing to administer a survey research project

After IRB approval has been obtained, the next step is to set a starting date.  After this, a little preparation is required to start administering the survey at the chosen location.

First, copies of the actual survey needs to be made, along with copies of the informed-consent forms, letters to the staff of the department where the survey will be administered (so all the staff know what you are doing in their waiting room), and copies of the flyer to advertise.

In addition, you have to prepare a small sign to set on your table to attract people to your desk in the waiting room.  You will also have to obtain a couple of clipboards and a dropbox with a lock/key, where patients can deposit their surveys.

Next, you will have to attend a meeting with the hospital manager, the physician you are assigned to, the head nurse, and the research coordinators of the program through your college of medicine.  Here, you discuss how you will approach patients, what days and times the survey will be administered, where your desk may be placed in the waiting room, and the like.

Finally, someone from the hospital department where you are conducting your research will give you a tour of the facilities and the staff.

Once these responsibilities have been met, the survey administration can start.

Navigating the tangles of the Institutional Review Board (IRB)

For my summer (my last official one ever) between M1 and M2 year, I designed a clinical research project where I try to get a better understanding of why or why not, patients tend to exercise. My argument was that understanding this would enable healthcare providers to find different and more effective ways of conveying the benefits of exercise to their patients. It would essentially enable healthcare workers to address concerns that some patients may not necessarily feel comfortable asking, while gaining insight as to why some patients don’t exercise regularly. Arming oneself with this information can help the clinician convey the importance and value of regular excerise to patients, instead of simply asking them to pay a visit to the gym for health reasons.  Also, clinicians can gain a better idea of why patients who exercise do so, and incorporate this advice into conversations with other patients.

This is my first clinical research project, and I’d like to inform you of the process that’s involved, starting with the arduous task of fulfilling the mountain of IRB requirements.  IRB stands for the Institutional Review Board.  There is usually an IRB established for each institution that conducts research, and their main goal is to make certain that fair and ethical protocols are followed in the use of human research subjects.

IRB application involves a long, boring application that asks you to detail how you plan to collect data and secure patient confidentiality, the length of the project, and other details like available remuneration, etc.  It also demands an informed consent form designed by the investigator (the researcher), which details the rights and responsibilities of the subjects and the researcher.  Basically, IRB wants to make sure that the patient knows exactly what they are getting themselves into, the reasons why, the benefits and risks involved, and the like.  If deception is an integral part of the project, then IRB needs to make sure that the benefits from deceiving patients temporarily outweighs any harm that is caused by the deception.  IRB exists to make sure that research projects like the Tuskeegee study does not happen again.

After this initial application is submitted, it goes through a pre-review.  A member of IRB reviews your application to make sure it’s filled out properly, with all the required information, along with suggestions for improvement.  This process goes back and forth a few times, after which your application is ready to undergo official review by the IRB board.  You cannot start your project until and unless you get the final approval letter after this review process is complete.

How long does all this take? About 4 months for a simple project involving human research subjects taking a 5-minute survey (not involving any drug administrations or hospital stays, which I’d assume takes longer and is a more cumbersome process).  So, if you are looking to conduct research during your M1-M2 summer, you need to have submitted your project to IRB by early March.  Don’t forget it takes some work to fill out the application and design the study prior to seeking IRB approval.

Further, the approval process cannot proceed until and unless you finish the IRB required training, and provide the review committee with certificates of completion.  This includes a handful of IRB training modules that takes a few hours to read and complete, and a HIPAA training that is required to help maintain patient confidentiality.

After the IRB approval letter was granted, it took me a week to prepare before starting the project.  Since my project is pretty simple, I’d imagine it could take longer to prepare for a more complicated project.

What’s involved in preparing to conduct a survey research project?  That’s the topic of my next research-related post.

Is research important?

Many of you wonder if research is important in applying to medical school.  A lot of people will tell you YES, it is important, while others will tell you that you should only conduct research if you find it interesting.

Below is my experience and advice regarding research and its importance.

I was a research assistant during undergrad for one semester, where I helped do some minor lab work like labeling plates, plating cultures, and screening colonies on plates with bacteria.  This experience, regardless of how insignificant it seems, helped me conduct the independent research project I would eventually conduct as a senior undergraduate student.  When I was interviewing with the lab’s Principle Investigator (lab head) for the independent project, I was able to show her that I had some experience in sterile technique, and now that I’ve had a lot of classes in cellular and molecular biology, I was ready to begin a supervised research project.

During my independent supervised project, I had the opportunity to create a design and plan experiments ‘1 on 1′ with the Principle Investigator (PI).  Further, I slowly read about lab techniques for various procedures, read the protocols available in the lab, etc.  While carrying out these experiments, I would read more about the science behind it in select textbooks (recommendations from the PI) and pertinent journal articles.  I started becoming competent as to how to read these scientific articles, and assess them for validity and experimental procedure.  I had to become very familiar with calculations regarding units such as millimoles, micromoles, microliters, milliliters, liters, ampheres, volts, etc.  At the end of the project, I was able to write a paper describing the research using sections such as the introduction, materials and methods, results, conclusions, graphs/data.  I was able to explain my research in layman’s terms (which is very hard to do for a beginner student).

At the end of the year long project, I had a better understanding of western blots, southern blots, chip assays, gel electrophoresis, PCR, bacterial cloning, restriction digests, and a whole bunch of other techniques.  I essentially had private tutoring from a PhD in the cancer department of our school.  Further, I developed an appreciation for the effort, time, and hard work it takes to develop a study design, execute it, analyze the results, modify the projected track, and conduct more experiments.

Yes, I was scared in the beginning, as I didn’t know if research was right for me.  I was afraid that I would mess up – which I did, multiple times, and on a few occasions, had to start the whole (sometimes 3-days-long) experiment all over again.  But, in the end, I got a small sample of how the material in our textbooks got there in the first place.  Without research labs and research folk, we won’t know as much as we do today.

That being said, let’s address how research can help you in the medical school application process.  You will have something to put down in the Research/publications section of the AMCAS.  And believe me, if you have research, it looks good.  It used to be that you will stand out, but these past few years, medical school admission has become so competitive that some programs may be surprised that you don’t have any research experience at all.  Something is surely better than nothing.  However, be prepared to talk about your research as you may be asked about it during interviews.  Also note that admissions interviewers who do ask you about your research can see right through you if you are bluffing or making stuff up.  Review your research before you go into your interview so you can talk at least semi-intelligently about it.  They don’t expect you to be an expert in the field; just show them you knew some of the science, what you got out of it, and what its implications are in the larger realm of things.

Research is important and medical schools and residency programs are stressing them more and more as the years go by.  Some residency programs now have required research components built into the program.  Others offer additional years during your residency to take time to do concentrated research.  Our medical school encourages us to do some sort of research during our summer between M1 and M2 years (our last summer off, ever).  This way you can show your residency interviewers that you didn’t sit around during the summer, and that you were actively involved in learning.

Probably the most important area where having conducted research as an undergrad was useful, at least for me, is applying to research programs for my M1-M2 summer.  There are a plethora of research programs targeted specifically at medical students where the program gives you a stipend to come to their school/program for about 2 months in the summer to go thru a research-training experience.  These are highly competitive, and is very similar to applying to medical school all over again.  The process requires personal statements, program-specific essays, demographic information, 2-3 letters of recommendation from medical school professors, a letter from the Dean, AND a resume-like questionnaire (with a space for prior research experience).  Having this prior research experience was useful in securing a position because they can see that you are sincere about research, and that you know what you are getting yourself into, during your last summer break.  During one of my interviews for one of these summer research internships, the interviewer concluded by saying, “Okay, from our little meeting, I can tell you are serious about conducting research, and that you have the critical thinking skills needed for designing and executing your own study.  You probably received that from your prior research experience.”  As you can see, he pretty much told me what he was looking for in potential candidates.

So, is research important?  I do believe so.  It has so many advantages that you cannot go wrong with any research experience you get.  If you are scared about the prospect of research, just talk to a few of your professors and see if they are willing to meet with you to give you some advice.  They may even take you into their labs and give you some beginner experience that way, to sort of feel it out.  If you really are interested in their research (or another PhD’s in your school), be bold and contact them.  They love it when people show interest in research.  They are willing to help; they know how you feel because these professors and scientists were in your shoes one day not too long ago.

If you have specific questions about research, feel free to leave a comment or e-mail me! ireason9@gmail.com