A Taste for Research: Krish Dewan, Part II

In Part II of this story, rising fourth-year College of Medicine student Krish Dewan talks about how doing research has enhanced his clinical and classroom work and what he learned from helping to prepare an article for publication in a top medical journal.

Read Part I.

How has doing research has enhanced your clinical and classroom work?

I would encourage any medical student, whether considering an academic career or not, to seriously consider conducting at least some research precisely for this reason. When done correctly and with the appropriate guidance, research develops some very critical skills in a budding physician:

1. Contextualization: Research contextualizes the material we learn early in the first few years of medical school in a way that forces one to take into account real-world implications of medical conditions and their etiologies.
2. Acceleration: Research has the potential to dramatically accelerate the learning process. Conducting a good clinical project requires a large fund of knowledge. You cannot create a proposal, let alone analyze data, without a solid foundational knowledge of the topic at hand. What does this mean? One must read! Often one of the first things a research mentor will do is hand students a stack of articles to peruse over a few nights. One is called upon to become an “expert” on the topic. This becomes even more important when presenting and publishing research work, as any work research is open game for criticism. One must be prepared to defend your data and conclusions, acknowledge its limitations, and highlight its relevance to daily practice.
3. Self-reliance and responsibility: A physician is called upon to make small decisions that have wide-reaching impacts. Research involves similar decisions. Especially for high- impact studies, the implications of a conclusion can spread far beyond one patient alone, hence it is critical that the design/methods of a study be scientifically sound, reproducible, and transparent. A researcher must therefore take ownership of decisions and learn to trust their instinct.
4. Critical thinking: By far one of the most applicable skill that is translatable from research to clinical practice is that of critical thinking. Physicians rely on landmark clinical trials, large studies and guidelines on a daily basis. There is no better way to critically analyze a study than having conducted one oneself. To understand the details of statistical minutia – perhaps a propensity-score matching algorithm or the measure of fit in a multivariable regression model – allows one not to just take a study’s conclusions at face value but to critically analyze the process it took to reach that conclusion.

 

You were an author, along with your twin brother, Karan Dewan, and Jay J. Idrees, M.D., Ph.D., on the article “Trends and Outcomes of Cardiovascular Surgery in Patients with Opioid Use Disorders,” published in JAMA Surgery. What did you learn in the process of helping to prepare an article for publication in this national, peer-reviewed journal? What went into the process that other medicine students might not guess?

Every journal has its own specifications for publication, some more strict than others. We are often told about the “peer-review” process in medical school. But one cannot truly appreciate how much goes into that process without having experienced it. There is much more work that goes on behind the scenes after submitting a paper for publication.

The revision process is lengthy and nerve-wracking! Your long hours of hard work are on the line. You may be asked to re-run an analysis. You may be asked to recollect additional data. Despite being one word short of the manuscript word limit, reviewers may add a laundry list of additional details that would be great to discuss. It is certainly a daunting task for a student to not only be responsible for balancing all these components, but also for defending the work.

Many times, reviewers may misinterpret a conclusion or a point in your discussion. It is the author’s job to recognize when writing is not necessarily clear enough, when the requested changes are already present in the manuscript, or whether the recommended changes cannot feasibly be made. One learns the art of communication paired with the importance of humility. In the end, the final product ends up being better every time!

It is currently my goal to become an academic surgeon. While the privilege of treating patients on a daily basis is highly rewarding in and of itself, the allure of being able to help shape the way we practice surgery as a field; to contribute to the wealth of knowledge in some way; and to be involved in teaching the next generation only serves to amplify that personal fulfilment.

Completing an M.D./Ph.D. program was not something I had actively sought out. However, M.P.H. and M.B.A. degrees are often offered as enrichment years in residency programs. I have not ruled out the possibility of pursuing one of these ancillary degrees to augment my academic career.