IAMSE Winter 2022 Session 2 Highlights

[The following notes were generated by Sandra Haudek, PhD.]

The Winter 2022 IAMSE Webinar Seminar Series, titled “How Science Educators Still Matter. Leveraging The Basic Sciences for Student Success” continued with its second seminar on Thursday January 13, 2022, titled “Research in Medical School – Impact on Career Path”. This seminar was presented by Dr. Rachel Wolfson, Assistant Dean of Medical School Research and Associate Professor of Pediatrics at the University of Chicago Pritzker School of Medicine. Using data from the medical education literature and the National Resident Matching Program, she discussed the impact of medical student scholarly activities on their skill development and career trajectory. She also debated how scholarly research might be addressed in the residency application process, including how program directors might use research participation and productivity as proxy measures of desirable characteristics among program applicants.

Dr. Wolfson started with discussing the landscape of medical student research participation. She explained that research during medical school is increasingly common and often supported by structured scholarly concentration programs providing protected time, dedicated mentors, and benchmarks for completion. However, a comparison of medical school curricula is difficult due to different elements such as optional versus required research projects, amount of protected time, nature of essential deliverables (e.g., poster versus published manuscript), different tracks in which inquiry projects have different emphasizes, and the definitions of what counts as scholarly (e.g., hypothesis-driven, statistical analysis). She points out that critical thinking skills can be learned from many different projects, and that these projects do not need to be a basic science research project. She further mentioned the Scholarly Concentration Collaborative (sccollaborative.uchichago.edu), a multi-center collaborative aimed to improve and grow opportunities for student research and discovery. Using AAMC medical school graduation questionnaire data of the last 6 year, she showed that with the number of medical research opportunities also the number of publications and poster presentations increased. Lastly, Dr. Rachel reviewed several papers that measured the impact of research on medical student education in single-center studies: Clin Trans Sci 2015, 8:479-483; Acad Med 2017,95(8):1196-1203; Acd Med 2018, 93:1727-1731; J Investing Med 2019, 67(6): 1018-23; Med Educ Online 2020, 25(1):176210; Acad Med 2012, 87:1582-1593. All discussed studies showed a positive correlation of research fellowships with increased number of publications, better residency match results, and more likely to attain academic positions.

Dr. Wolfson then continued with discussing the impact that research participation has on student career trajectory. She debated if students should do research during medical school? Her institution’s curricular goals are the following: Become critical scientific thinkers (hypothesis, approach, evaluation, dissemination), develop self-directed learning skills, and develop and sustain interest in career-long research even if these students do not become NIH-funded researchers. Yet when medical students were asked about their goals, they listed “developing a strong mentoring relationship with a faculty mentor” and “enhancing competitiveness for residency match” above any skill development goals (Medical Education 2017; 51(8): 852-860). Listing anecdotal but consistent data, Dr. Wolfson further elaborated on students’ concerns which included: Success in research is important in highly competitive specialties and probably even more important when USMLE Step 1 becomes pass/fail, thus publications or scholarly work in these competitive fields of interest (not in other fields) are critical. Yet research projects are not always possible or easily attainable in such fields, and/or at the beginning of medical school, students do not know yet which specialty they will choose.

Dr. Wolfson then discussed how resident program directors regard scholarly work in evaluating applicants. She reviewed several papers addressing the program directors’ point of view. One large survey study from 2009 indicated that scholarly work was at the bottom of their selection criteria, yet was decisive for ranking when all applicants were “outstanding” in their score criteria (Academic Medicine 2009, 84:362-367). She then lists a sampler of several specialty-specific studies indicating that the emphasis on research as an important selection criteria increased over the last years. Lately, the concern arose that when Step 1 goes pass/fail, students will look more similar and research may be emphasized even more. This leads to the question if today’s goal to include research in the medical school curriculum is really to educate future researchers or is actually to enhance residency matching? And further, is success in research an independent variable, or is it a proxy for another applicant characteristic, such as for enhanced communication and teamwork skills, intellectual curiosity, perseverance, or commitment?

Dr. Wolfson then reviewed data from the National Resident Matching Program (NRMP). She first presented the 2020 match data illustrating the mean number of research experiences of US medical students correlated to matching results per specialty field. These data showed very clearly that only in the highly competitive specialties, such as dermatology, neurological surgery, plastic surgery, and radiation oncology, students who matched had more research publications and poster presentations than students who did not match. Dr. Wolfson then continued with a discussion of the NRMP program director survey 2021. Interestingly, NRMP groups the criteria “involvement of research” and “interest in an academic career” not under the “education and academic performance characteristics” but under the “personal characteristics and other knowledge of applicants”. The data then indicated that only 41% of program directors scored the first criteria and 24% the second criteria as important decision factors for selecting an applicant for an interview. Even fewer program directors considered these two criteria as important for ranking applicants. To highlight these trends, Dr. Wolfson further discussed the breakdown data for neurosurgery, dermatology, and pediatrics as examples. Lastly, she mentioned that, as part of the Scholarly Concentration Collaborative, her team is currently involved in a similar, still ongoing study. In this study, they are surveying >5000 program directors with the goal to understand and describe the relevance of medical student research among residency program directors. Their goal is to obtain more details as to what type of research and in which specialty field research may be important, and how this will change with USMLE Step 1 going pass/fail.

In conclusion, Dr. Wolfson summarized that the USMLE step 1 score was important for getting an interview (which, unfortunately, may be USMLE step 2CS in the future), but other characteristics such as scholarly work, including number of research presentations and publications, were decisive for ranking especially in highly competitive specialty fields. This emphasis on research may intensify even more, as well may become visible on other less competitive specialties once USMLE Step goes pass/fail. Dr. Wolfson then stated that scholarly concentration programs are opportunities for mentorship, role modeling, teaching beyond project completions (soft skills), and balance between critical thinking, research development, and success in residency match. The presentation lasted about 45 minutes, followed by a lively discussion addressing questions from the audience. These questions probed if students should take a year off before, during, or after medical school to do scholarly work, and how students deal with the effects of the pandemic during which scholarly research may have been less accessible.