I Have This ‘Research Month.’ What Should I Do with It?
All residents at Stanford are guided by a core mentorship group consisting of a senior and a junior faculty member as they pass through rotations, choose a specialty, prepare a curriculum vitae (CV) and begin to make career plans. In their second and third years, residents have a research block of up to one month each year — free from clinical responsibilities — which often involves a different mentor to introduce them to academic research. Here, three faculty mentors tell how they approach this opportunity — with a few specific results their residents have achieved.
A Very Experienced Mentor
Mindie Nguyen, MD, MAS, an associate professor of gastroenterology & hepatology, is currently mentoring a third-year resident, three second-year residents and one intern.
With experience mentoring three to five residents annually for many years, Nguyen says, “I tailor it to each of them depending on their clinical and research interests and what they need the most from me, and I am always conscious of their timeline. They generally need to show results of their work by the time of fellowship application, which is usually only about a year to two after meeting me.”
Nguyen meets individually with each resident, asks them about their background and what they enjoy, and reviews their CV and prior experience. She describes for them the types of studies her lab does, examples of prior residents’ projects and the data she has available to them. Then she lets them choose a topic: liver cancer, fatty liver disease, hepatitis B or hepatitis C, and then a specific project from available options.
Nguyen’s goal for each of her mentees is to complete at least one first-authored publication. This requires a focused project that they can finish in less than two years.
Nguyen meets with her mentees individually as often as once or more a week during their research month and as needed. And she gives each of them what she describes as a “one-hour introduction to epidemiology/study design in a nutshell.”
Alina Kutsenko, MD, is the third-year resident being mentored by Nguyen. During her research period in the Nguyen lab, she found that patients with hepatocellular carcinoma differed in presentation, treatment and survival according to whether they had concurrent metabolic syndrome. She has presented these data at two major academic conferences and has a first-authored publication currently in press. She is also working on her second project, building on the niche she has developed with liver cancer and metabolic syndrome.
Transitioning from Mentee to Mentor
Sometimes a successful mentee becomes a successful mentor in just a few years. This was the case for assistant professor Mintu Turakhia, MD, a cardiac electrophysiologist; Alex Perino, MD, a cardiology fellow; and three residents who began the project as interns, during the fall of 2015.
Perino, who had been mentored by Turakhia for several years, describes the project: “This year, Mintu enabled me to assist in the mentorship of George Leef, Andrew Cluckey and Fahd Yunus on a grant-supported project we call SMASH-AF (systematic review and meta analysis of ablation strategy heterogeneity in atrial fibrillation). Published success rates of AF ablation procedures ranged from 20 to 90 percent. Our goal was to figure out what drove this significant variation in outcomes. We performed a massive systematic review, screening 9,000 articles, ultimately including 400 that met our criteria, which had more than 540 treatment arms and 65,000 patients, with over 400 unique variables abstracted per article.”
He continues: “We also utilized a research group structure and philosophy that increased mentee responsibility, resulting in greater mentee growth and project productivity.”
Leef provides an example of mentee responsibility: “Alex and Mintu wanted us to take an active part in creating the abstraction rules. Since we were the ones reviewing the articles, we were in the best position to adapt the rules as new situations arose, and it was also a valuable learning experience for us.”
The first four abstracts from this remarkable meta-analysis were submitted to the American Heart Association for its annual meeting in November 2016; two were accepted as poster presentations. Perino anticipates an additional 25 hypotheses to explore from the massive database, and “this is just the tip of the iceberg,” he says.
Perino credits Turakhia with providing a template for him to follow as a mentee. “Mintu did not just give me work to do,” he says; “he taught me how to be independently productive.” About this particular project, Turakhia says, “What’s cool here is teaching these residents about team science and collaboration early in their careers.”
Residents Delving into Residents’ Responsibilities
The final mentor-mentee project focuses on a topic of particular interest to residents: trying to find the sweet spot in balancing their inpatient responsibilities with their duty to outpatients who have problems or questions between appointments. There was a fair amount of anecdotal information among residents about finding the right balance, but there were no data.
The senior author and a mentor of the residents on this project, clinical associate professor of hospital medicine Jeffrey Chi, MD, had requested that data be retrieved from EPIC, Stanford’s electronic health record, in 2013. A year later he received a data set that contained information about all the things that residents did that were recorded in EPIC. It was a treasure trove.
At that point, Chi recalls, “While I could guide the research methodology, ultimately the residents know the right questions to ask. They know where the stress points are.”
The residents who took part in the project were Jason Hom, MD, Jonathan Chen, MD, PhD, and Ilana Richman, MD. Additional mentors were Baldeep Singh, MD, who is a clinical professor of general medical disciplines, and Casey Crump, MD, PhD, who at the time was director of the Center for Primary Care Research.
Chi and Hom had worked together throughout Hom’s residency and “had already established a good working relationship,” according to Chi. He was confident that Hom and his colleagues were both accomplished and highly motivated.
Hom explains that they wanted to address “a topic relevant to house staff that has implications for how residency programs design inpatient and outpatient responsibilities. Jeff had done a great job of acquiring a difficult-to-acquire data set, and we wanted to use it to try to answer that question. It was nice to generate some solid data to help inform the discussion.”
The resulting manuscript was published in BMC Medical Education in May 2016. The results were not surprising: They found that at the time of the study it was difficult for residents on busy inpatient rotations to pay equivalent attention to outpatients with between-visit problems.
Hom states, “Stanford is wonderfully supportive of residents and very innovative in its approaches, and based on resident feedback, Stanford now employs a popular ‘firm system’ that uses team-based care to help with patient between-visit problems, which improves the trainee experience and also patient care.”