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Research and the surgical trainee in the UK
LEADING ARTICLE
Research and the surgical trainee in the UK
Professor Sophos: That is true; in order to be shortlisted for an interview (in addition to basic surgical skills), you need to show prowess in a number of areas related to surgery, and to demonstrate your commitment and interest in the discipline.
C H Fry
Mr Lut: That was how it was explained to me. I was told that I should speak to you because you have supervised many surgical trainees who are now specialist registrars and consultants. I would like to start a research project because I think I have done enough basic surgical training, My consultant says that he knows you and so it should be allright.
C-Y Li
Professor Sophos: When do you finish your surgical post?
‘The fairest thing we can experience is the mysterious. It is the fundamental emotion that lies at the cradle of true art and true science. He who knows it not, who can no longer feel amazement, is as good as dead, a snuffed-out candle.’ Albert Einstein
Mr Lut: In about six weeks’ time; I have not applied for any clinical jobs. I want to take a holiday and then I will be ready to start research in a couple of months.. Deutera: (to the accompaniment of harps and a tinkling stream) This all sounds very reasonable. Mr Lut has carried out the required basic surgical training, and gone to see a urologist about how to get a specialist training post in that research area.
The problem: to pee or not to pee, that is the research question The setting The setting is the laboratory of a physiologist at the Institute of Urology and Nephrology, University College London, London, UK. The Institute achieved the highest grading in the last Research Assessment Exercise and therefore has to maintain scientific work of the highest international standard. Research is directed at the normal cellular and systems physiology of the lower urinary tract and the information is used to gain insight into the disorders of the tract that affect human patients. Scientists (postgraduate, postdoctoral) and clinical trainees work in the laboratory. The players Professor Sophos Mr Lut (MRCS) Deutera
Professor Sophos: Mr Lut, I have some questions for you. I must maintain a centre of scientific excellence and ensure that the university continues to employ me. Do you have a special interest in the pathophysiology of smooth muscle of the lower urinary tract? What skills do you have that recommend you to laboratory research and how will you contribute to the scientific output of my research group? Do you realize this project would be a full-time undertaking for at least two years? (Ironically) Presumably you have acquired funding for your salary, running costs and university fees—from where did you obtain the funding?
Professional physiologist Surgical trainee Muse
Absolute silence Mr Lut: (In a coffee bar shortly afterwards). Suddenly this does not seem so straightforward. I thought you went into a laboratory and did experiments that were allocated. I do not really know enough about urology to decide what area I want to work in (oncology? stone research? urodynamics? tissue physiology?) What can I offer? I did an intercalated BSc in biochemistry, but that was years ago and I cannot remember anything about the subject now. Where will the money come from? I have heard that the usual way to get funding is to write a grant application (however one does that), and this can take up to one year. I will have to take another couple of rotations in orthopaedics and thoracic surgery; I am getting older. My consultant did not tell me the scientist would ask such questions.
The discourse Professor Sophos: I am pleased to meet you. Why do you wish to speak to me? Mr Lut: I want to be a urologist and hope to get an specialist registrar post. I feel I have done enough basic surgical training and am ready to move to the next stage of my career. Professor Sophos: Very good! But why do you wish to speak to me? Mr Lut: I have been told that in order to get a specialist registrar post I should have carried out good research and preferably obtained a higher research degree.
The solution The dilemma that Mr Lut is facing is not unusual in the UK. The surgical trainee must ask some very important questions before he tries to start a research project.
C H Fry y is a Professor of Cellular Physiology at the Institute of Urology and Nephrology, University College London, London, UK. C-Y Lii is a Clinical Research Fellow at the Institute of Urology and Nephrology, University College London, London, UK.
SURGERY 22:12
310
© 2004 The Medicine Publishing Company Ltd
LEADING ARTICLE
Why carry out research? The attainment of research skills is essential to the training of a specialist registrar, even if he does not wish to pursue a career in academic surgery. Such skills include the ability to: • evaluate critically the scientific literature and studies performed by others • plan and execute experiments or clinical trials • appreciate the routes whereby scientific advance proceeds • accumulate transferable skills that one may not otherwise accrue (e.g. public speaking, scientific writing, IT skills, familiarity with statistical methods). These skills enable the individual to: • approach the subject in a balanced manner • play a role in the development of the discipline • understand the basis of current practice.
time to perform research in a subject in which you have not yet started specialized training is another matter. Which type of research is best? This is a difficult question, but an important one to address because you may as well do it in an area that you enjoy and may even want to pursue later. My advice is: • define the subject areas of your chosen specialty • research these areas • see which one(s) are the most attractive. Also, you must decide whether you favour clinical, laboratory or epidemiological research. How to get a place Plan: you must plan 12–18 months ahead. Unfortunately, this is a time when your most immediate thoughts are towards the MRCS examination, and also when you have not decided your particular speciality. You can divide your planning into a series of steps. Decidee upon the specialist area, speak to people within the field about subspecialty areas and discover what research is progressing in these fields. Speak k to someone in the subspecialty areas that interest you about the particular research directions and where the good laboratories are. Your research must be carried out in a professional environment because: • it is easier to obtain funding • the work is likely to be better supervised • facilities are better and more readily available. Identify good supervisors and arrange to meet them. Most supervisors are pleased to talk to trainees, especially if they show evidence of having done some background work; no one expects you to be an expert, just someone with an intelligent interest. When you identify a potential supervisor and he can (in principle) accommodate you, discuss a research topic in broad terms and identify a hypothesis and the general experimental objectives.
What is a research degree? Two types of research degree are available to a surgical trainee: an MS (or MD) degree and a PhD. How are research degrees organized? Old system: in the past, an MS degree was termed an ‘unsupervised’ degree because: • there was no formal requirement for a supervisor • the minimum registration time was one year • the individual was regarded as sufficiently able to proceed with a project and write a thesis. A PhD required a supervisor and a minimum registration period of two years. New system: many universities in the UK now stipulate a minimum period of study of two years for an MS, and three years for a PhD; the MS is becoming a supervised degree. It seems reasonable that research degrees are supervised formally because few trainees can arrange their own experimental programme, execute it and write it without supervision. Hence, the number of people who write their thesis will increase because failure to do so reflects poorly on the individual and the supervisor. However, there are other issues. • A longer registration time means that the research period must be planned earlier and more carefully because a longer time away from clinical medicine may be necessary. • The designation of an MS as a supervised degree means that university fees are payable at the level of ‘taught degree’. These fees are significant (more than £2000 per annum) and need to be sustained for two or three years; it is a significant financial burden.
Funding is the most difficult problem. ‘Soft’ money may be available but, more likely, grant applications will have to be written. A good supervisor will help you because you cannot do this on your own. You can help to find out about the clinical background for example, but the costings, experimental protocol, etc. will need careful analysis. Find out the deadlines for grant submissions, and the likely sources of funding (www.rdinfo.org.uk). This is a lengthy and often disheartening procedure because applications are not always successful, hence several will have to be made. However, if the planning has been carried out in good time, you will be able to embark on an enjoyable journey through a topic of your own choosing, in a specialty that you may help to develop.
Which degree is best? If you wish to follow a degree in academic medicine, a PhD will give you a longer training period in which you can pursue an area in greater depth than an MS. However, you should be able to do good work in two or three years in a good training environment. When should you carry out research? The choice of when to do research training is currently fairly limited to the end of the senior house officer period because it helps in obtaining a specialist registrar number. Whether this is the best
SURGERY 22:12
311
© 2004 The Medicine Publishing Company Ltd
Research and the surgical trainee in the UK
Professor Sophos: That is true; in order to be shortlisted for an interview (in addition to basic surgical skills), you need to show prowess in a number of areas related to surgery, and to demonstrate your commitment and interest in the discipline.
C H Fry
Mr Lut: That was how it was explained to me. I was told that I should speak to you because you have supervised many surgical trainees who are now specialist registrars and consultants. I would like to start a research project because I think I have done enough basic surgical training, My consultant says that he knows you and so it should be allright.
C-Y Li
Professor Sophos: When do you finish your surgical post?
‘The fairest thing we can experience is the mysterious. It is the fundamental emotion that lies at the cradle of true art and true science. He who knows it not, who can no longer feel amazement, is as good as dead, a snuffed-out candle.’ Albert Einstein
Mr Lut: In about six weeks’ time; I have not applied for any clinical jobs. I want to take a holiday and then I will be ready to start research in a couple of months.. Deutera: (to the accompaniment of harps and a tinkling stream) This all sounds very reasonable. Mr Lut has carried out the required basic surgical training, and gone to see a urologist about how to get a specialist training post in that research area.
The problem: to pee or not to pee, that is the research question The setting The setting is the laboratory of a physiologist at the Institute of Urology and Nephrology, University College London, London, UK. The Institute achieved the highest grading in the last Research Assessment Exercise and therefore has to maintain scientific work of the highest international standard. Research is directed at the normal cellular and systems physiology of the lower urinary tract and the information is used to gain insight into the disorders of the tract that affect human patients. Scientists (postgraduate, postdoctoral) and clinical trainees work in the laboratory. The players Professor Sophos Mr Lut (MRCS) Deutera
Professor Sophos: Mr Lut, I have some questions for you. I must maintain a centre of scientific excellence and ensure that the university continues to employ me. Do you have a special interest in the pathophysiology of smooth muscle of the lower urinary tract? What skills do you have that recommend you to laboratory research and how will you contribute to the scientific output of my research group? Do you realize this project would be a full-time undertaking for at least two years? (Ironically) Presumably you have acquired funding for your salary, running costs and university fees—from where did you obtain the funding?
Professional physiologist Surgical trainee Muse
Absolute silence Mr Lut: (In a coffee bar shortly afterwards). Suddenly this does not seem so straightforward. I thought you went into a laboratory and did experiments that were allocated. I do not really know enough about urology to decide what area I want to work in (oncology? stone research? urodynamics? tissue physiology?) What can I offer? I did an intercalated BSc in biochemistry, but that was years ago and I cannot remember anything about the subject now. Where will the money come from? I have heard that the usual way to get funding is to write a grant application (however one does that), and this can take up to one year. I will have to take another couple of rotations in orthopaedics and thoracic surgery; I am getting older. My consultant did not tell me the scientist would ask such questions.
The discourse Professor Sophos: I am pleased to meet you. Why do you wish to speak to me? Mr Lut: I want to be a urologist and hope to get an specialist registrar post. I feel I have done enough basic surgical training and am ready to move to the next stage of my career. Professor Sophos: Very good! But why do you wish to speak to me? Mr Lut: I have been told that in order to get a specialist registrar post I should have carried out good research and preferably obtained a higher research degree.
The solution The dilemma that Mr Lut is facing is not unusual in the UK. The surgical trainee must ask some very important questions before he tries to start a research project.
C H Fry y is a Professor of Cellular Physiology at the Institute of Urology and Nephrology, University College London, London, UK. C-Y Lii is a Clinical Research Fellow at the Institute of Urology and Nephrology, University College London, London, UK.
SURGERY 22:12
310
© 2004 The Medicine Publishing Company Ltd
LEADING ARTICLE
Why carry out research? The attainment of research skills is essential to the training of a specialist registrar, even if he does not wish to pursue a career in academic surgery. Such skills include the ability to: • evaluate critically the scientific literature and studies performed by others • plan and execute experiments or clinical trials • appreciate the routes whereby scientific advance proceeds • accumulate transferable skills that one may not otherwise accrue (e.g. public speaking, scientific writing, IT skills, familiarity with statistical methods). These skills enable the individual to: • approach the subject in a balanced manner • play a role in the development of the discipline • understand the basis of current practice.
time to perform research in a subject in which you have not yet started specialized training is another matter. Which type of research is best? This is a difficult question, but an important one to address because you may as well do it in an area that you enjoy and may even want to pursue later. My advice is: • define the subject areas of your chosen specialty • research these areas • see which one(s) are the most attractive. Also, you must decide whether you favour clinical, laboratory or epidemiological research. How to get a place Plan: you must plan 12–18 months ahead. Unfortunately, this is a time when your most immediate thoughts are towards the MRCS examination, and also when you have not decided your particular speciality. You can divide your planning into a series of steps. Decidee upon the specialist area, speak to people within the field about subspecialty areas and discover what research is progressing in these fields. Speak k to someone in the subspecialty areas that interest you about the particular research directions and where the good laboratories are. Your research must be carried out in a professional environment because: • it is easier to obtain funding • the work is likely to be better supervised • facilities are better and more readily available. Identify good supervisors and arrange to meet them. Most supervisors are pleased to talk to trainees, especially if they show evidence of having done some background work; no one expects you to be an expert, just someone with an intelligent interest. When you identify a potential supervisor and he can (in principle) accommodate you, discuss a research topic in broad terms and identify a hypothesis and the general experimental objectives.
What is a research degree? Two types of research degree are available to a surgical trainee: an MS (or MD) degree and a PhD. How are research degrees organized? Old system: in the past, an MS degree was termed an ‘unsupervised’ degree because: • there was no formal requirement for a supervisor • the minimum registration time was one year • the individual was regarded as sufficiently able to proceed with a project and write a thesis. A PhD required a supervisor and a minimum registration period of two years. New system: many universities in the UK now stipulate a minimum period of study of two years for an MS, and three years for a PhD; the MS is becoming a supervised degree. It seems reasonable that research degrees are supervised formally because few trainees can arrange their own experimental programme, execute it and write it without supervision. Hence, the number of people who write their thesis will increase because failure to do so reflects poorly on the individual and the supervisor. However, there are other issues. • A longer registration time means that the research period must be planned earlier and more carefully because a longer time away from clinical medicine may be necessary. • The designation of an MS as a supervised degree means that university fees are payable at the level of ‘taught degree’. These fees are significant (more than £2000 per annum) and need to be sustained for two or three years; it is a significant financial burden.
Funding is the most difficult problem. ‘Soft’ money may be available but, more likely, grant applications will have to be written. A good supervisor will help you because you cannot do this on your own. You can help to find out about the clinical background for example, but the costings, experimental protocol, etc. will need careful analysis. Find out the deadlines for grant submissions, and the likely sources of funding (www.rdinfo.org.uk). This is a lengthy and often disheartening procedure because applications are not always successful, hence several will have to be made. However, if the planning has been carried out in good time, you will be able to embark on an enjoyable journey through a topic of your own choosing, in a specialty that you may help to develop.
Which degree is best? If you wish to follow a degree in academic medicine, a PhD will give you a longer training period in which you can pursue an area in greater depth than an MS. However, you should be able to do good work in two or three years in a good training environment. When should you carry out research? The choice of when to do research training is currently fairly limited to the end of the senior house officer period because it helps in obtaining a specialist registrar number. Whether this is the best
SURGERY 22:12
311
© 2004 The Medicine Publishing Company Ltd