Objective: Understand the clinical relevance of scientific inquiry and demonstrate the ability to evaluate emerging knowledge and research as it applies to diagnosis, treatment and the prevention of disease.
My first experience with research began at Miami University in a small quantum optics lab that focused on defining the refractive error in biologic substances. At every level of the research I felt over my head. I grasped for an understanding of the fundamental physics that helped propel our work. The complexity of the lab was highlighted in the basic science nature of the research. My time was spent running repeated trials and I got my first exposure to complex statistical analysis. My involvement in the lab grew with my years at Miami and I learned the science behind my research, and more importantly I was able to take responsibility for long runs of experiments including the data analysis. This experience highlighted for me that research can be limited by its applications. While I worked tirelessly on modifying the understanding of refractive index to account for the turbidity of biologic substances I was limited by the applications of my findings. We had made a monumental change in understanding of total internal refraction but it felt like there was little need for our change. Towards the end of my time at Miami University, I had the opportunity to present my research as an invited talk at the annual American Physics Society conference and I distinctly remember the last question in the Q&A session “what is the next step of your research, the bigger picture?” I of course stumbled through some answer but it made me pause.
Ultimately what I learned from my first research experience, really resonates with the medical knowledge objective which states “Understand the clinical relevance of scientific inquiry and demonstrate the ability to evaluate emerging knowledge and research as it applies to diagnosis, treatment and the prevention of disease.” What I was missing at a basic level was the understanding of the relevance of my scientific inquiry.
The first year of medical school was a whir, and as the year pressed forward we were urged to explore how we could best spend our summer. The goal of my summer plans were to reshape my understanding of research and its implications. I wanted to pursue a project which focused on clinical research and clinical outcomes, and had the potential to exact a change on current practice and guidelines. I met with multiple faculty members regarding potential projects and tried to frame my search for research in a new lens. I wanted to work with a preceptor who helped me focus on the relevance of my work and more importantly knowing that the research I conducted would dictate clinical practice.
I chose to work with Dr. Debra Zynger on a joint project that would be conducted between the departments of Pathology and Urology. The project had the lofty goal of better characterizing the variability that exists between Urologist within the OSU system regarding prostate biopsy variables and outcomes and understanding whether certain prostate variables had an impact on cancer detection rates. The MDSR summer research program started my journey with clinical research. Even in the application I was asked to visualize the impact of my project.
The project began with assembling a database of approximately 1,500 patients. Each entry required a close evaluation of the patient’s chart—dissecting out the pertinent portions of the pathology reports and procedure notes. I immediately could see the stark contrast between my first research experience and the research I had begun. The goal in collecting data and analyzing it had tangible effects. It had the potential to demonstrate if significant difference existed between Urologists regarding their cancer detection and equally as important were certain variables (prostate core length, number of biopsy cores) more important in detecting cancer? I was able to take a leadership role in this project. Each aspect of the project from data collection to working with the statistician and finally assembling the manuscript were squarely in my hands.
Through my research I found there was significant difference between Urologists within a single institution which highlighted the variability that exists within training. We also realized that the most important prostate biopsy variable is the total tissue. So essentially with fewer cores and containers, which subsequently decreases costs to the patients and the health care system, you don’t lose the ability to detect cancer. The impact for this project at an institutional level was immense. It helped justify reducing container number for prostate biopsies and limiting biopsy prostate schemes in an effort to balance cost, harm to patient and outcome for diagnosis, while grounded in evidence based medicine. Additionally because the project allowed for evaluating patients who underwent multiple biopsies I was able to chart the relationship between initial diagnosis and its predictive value for future diagnosis on prostate biopsy. This was critical in the relationship between prostate biopsy results and treatment outcomes. Based on the data for which diagnoses most often led to a future diagnosis of cancer, patients could be safely stratified into watchful waiting treatment groups.
The project culminated in a first author publication and two poster presentations at a national conference. I felt an immense difference in this project compared to previous work. I could directly see the impact my work had on the medical field and I was able to share my findings with the medical community through multiple forums.
As I reflect on the entirety of my research experience throughout medical school there are some key points that I would like to take forward with me as I continue to base my career on evidence based medicine. Mentorship played a huge role in the success of my project. In working with Dr. Zynger, I was able to take accountability for the project, but with the added support of a seasoned researcher who helped me navigate the process. From applying for an IRB to requesting funding, her mentorship was instrumental. Her guidance also helped to emphasis the bigger picture of my work. She clued me in to what would impact clinicians on a daily basis regarding prostate biopsies and how our research could fill gaps in knowledge. As I move forward into residency I hope that future projects will also be coupled with mentorship.
My next research project will be started when I am in a place in my medical career to begin asking questions that will directly affect the way I practice. My previous project demonstrated that research has the biggest effect when it directly impacts clinical decisions. Moving forward I will approach projects based on the focused questions they can answer, and what void in medical knowledge the research can fill. As I reflect on what the next steps are for me regarding my ability to evaluate emerging knowledge and research as it applies to diagnosis and treatment I would like to gain more familiarity and involvement with clinical trials.