Medical trainees under too much pressure to do research
In medicine, the worth of medical students and residents is too often defined by their number of research publications.
Research is a well-recognized way for medical students to distinguish themselves when applying for prestigious residency positions. A recent opinion piece published in the British Medical Journal remarks that research has become a “shortsighted, insincere effort,” with students seeing it as no more than a way to generate another line on their CV.
The expectation of research continues into residency. Research is a requirement for residents in many Canadian post graduate training programs, including family medicine, internal medicine,psychiatry, general surgery, and obstetrics and gynecology.
Yet despite this emphasis on research during training, the average practicing Canadian physician spends less than three percent of her work week on research, according to the National Physician Survey.
This unrelenting pressure to conduct research can cause distress to students, and the time consuming nature of research may also dissuade them from pursuing other important professional interests.
Some medical trainees have a strong enthusiasm for research, and devote large portions of their time to the pursuit of scientific discovery. They seek the intellectual stimulation research provides, are eager to solve unanswered clinical questions through research, and thrive with the mentorship and networking opportunities research offers.
But some trainees are more interested in medical education, global health, health economics and policy, or quality improvement. Although these non-research interests are recognized by the Royal College of Physicians and Surgeons of Canada, the immense pressure to conduct research can propel some trainees to set their true professional interests aside. They begrudgingly participate in research just so they can fulfill residency program requirements or maintain competitiveness for residency, fellowship, or staff positions.
This not only creates unenthusiastic researchers, it leaves little room for trainees to develop those other interests. Alternatively, some trainees feel pressured to turn endeavors that are not traditionally within the research realm into scholarly publications, because academia’s doctrine of “publish or perish” has, unfortunately, also become the norm in medical training.
It’s time for these issues to be recognized and addressed.
We need to reduce the pressure on medical trainees to exclusively conduct research. Medical schools and residency programs should encourage trainees to excel in any domain they are passionate about. The pursuit of these other passions may change how future generations of doctors are educated, lead to improvements in care in low-resource settings, deliver measurable and continuous improvement to patients at the frontlines or improve how healthcare policy decisions are made.
This perspective has been adopted at the University of Toronto’s Department of Medicine, which trains internal medicine residents. The guiding principle has now become that all internal medicine residents must engage in “the generation and translation of new knowledge to impact health,” instead of focusing solely on research.
There should also be a shared responsibility between the programs and the students as Canadian universities vary in their institutional focus on research. Canadian medical programs that consider training academics one of their goals should make that clear to applicants to promote the best fit between the program and the applicant. Similarly, those who choose to train in more academically oriented programs should embrace the scholarly opportunities offered at these sites.
At the same time, a national Canadian survey found that trainees pursuing research report barriers that limit their full potential. These include lack of funding, shortage of research mentors, research time competing with other responsibilities, and the lengthy and confusing research ethics process. These restrains prevent even the most motivated trainees from conducting high-quality research that will truly impact the field, because they are just unable to commit to more demanding and substantial projects. Providing protected research time in the curriculum, research mentorship opportunities, and streamlining the ethics approval process are all potential solutions institutions can adopt.
Without question, research innovation and discovery push evidence-based medicine forward. Still, some medical trainees have other passions that can result in equally valuable contributions to medicine. No matter what trainees wish to pursue, let’s give them the support they need to excel.
Annie Wang is a third year medical student at the University of Toronto. Helene Retrouvey is a third year resident in the Division of Plastic and Reconstructive Surgery at the University of Toronto. Gillian Hawker is the Chair of the Department of Medicine at the University of Toronto.