spending quality time with the next best thing to family, fostering long-term friendships, becoming less homesick, and creating a sense of belonging away from home.Challenges to undertaking research
Ethics and research governance
Tips for getting involved in research
It can be very helpful to have a mentor or senior peer who takes an academic or pastoral interest in your career throughout medical school.
Many universities will allocate a clinical supervisor or tutor who is available for informal advice or more structured assistance where necessary. They will also provide a reference for your job application and will be the first point of contact for any pressing issues with the medical school. It is important that you maintain a good working relationship with your tutor otherwise they will not have much to go by except for your academic records. You may wish to forge your own links, perhaps within a speciality of your interest. Be clear with yourself why you are doing this; people will be able to detect obsequiousness a mile off, but will respond much better if you have a clear goal such as becoming involved in a research project.
If you wish to make yourself known within a clinical specialty, a good place to start is with the ward team. Get to know the junior trainees and the registrars, and make an effort to attend clinics, ward rounds, or theatre sessions. You may identify a particular area of interest and approach the consultant with ideas for an audit, case review, or literature search. Taking the initiative is very much encouraged, noticed, and supported. Similarly, many specialities have nurse specialists who are a mine of useful information and may also be able to suggest suitable fields for study (and critically know how to gather this information). Remember that your interests can extend beyond the clinical curriculum, e.g. you may wish to get to know people with similar religious/political/sporting/social inclinations.
Many medical schools will have medical student societies for those with a particular interest, e.g. in surgery or paediatrics. Local and informal meetings may be a good introduction. If your medical school does not have such a society, why not start your own with the help of the student union? Ask a consultant to act as your patron or director and approach your student union, your members, organizations, and companies for funding. This will show great initiative. If these are going well, why not join with similar societies at other medical schools or form a national society for medical students interested in the same subject matter? Social media is an easy of way of gaining interest and publicizing events/causes.
There are a number of online sites where like-minded (and frequently diametrically opposed) medical professionals exchange views and information. Be mindful of GMC guidance on doctors’ use of social media.
Most specialities are keen to engage trainees and medical students from an early stage in their career. Check their websites for free/reduced conference registration, student-focused meetings, and funding opportunities.
National conferences are a great way to meet people within a specialty. Student participation is greatly encouraged yet remains relatively rare. Medical students who present posters or oral presentations stand out (for the right reasons) and are spared from the more direct lines of questioning afterwards! Organizing your own conference will make you stand out, but do not underestimate the amount of work and responsibility involved. You will need to find funding (often from medical industry, perhaps ask a friendly consultant to make an introduction on your behalf), a venue, and facilitate registration, catering, etc. The most rewarding part of conference organization can be choosing a suitable programme and your ‘fantasy line-up’ of speakers. You will be amazed by the good will shown to such endeavours and many eminent people will offer their services for free.
Getting involved from the patient’s perspective can be truly eye opening, and your involvement will be encouraged. You may start with voluntary or fundraising work and then take a more active role in committee management. Most charities have a medical advisor, why not start early? There is a misconception that medical students can only do some good after graduating as a doctor. In fact, society in general will be keener to help ambitious and righteous students who have the time and energy to invest in making a positive change. Once you start working, it becomes more difficult to dedicate your precious free time to big events.
Leaving home and going to university opens up a panoply of new opportunities, of which you should take full advantage. Many medical students continue an existing interest at a higher level, e.g. sports or music, or try something entirely new. However, unlike many other undergraduate courses, the demanding and rigid scheduling of the preclinical and clinical courses does not accommodate other activities easily. A Classics student may be able to spend two entire days each week playing university-level rugby and fit in self-directed learning around this, but the medical student timetable is generally full from 9 a.m.–5 p.m., Monday to Friday (and at some medical schools, Saturday too!).
This is not to say that it is not possible to do both things well. Medical schools are rightly proud of the extracurricular achievements of their students. The selection committee have chosen you to act as an ambassador for the university and in return, you will be expected to contribute to your university, much like helping them to help you. A good doctor is someone with the skills required to take a step back from medicine to see the bigger picture, not to mention the direct benefits of having other interests outside of work. This guide is not intended to explain the variety of extracurricular activities available to you at medical school but to offer some tips for how to succeed in medicine and something different.
Paraphrased advice from an Oxbridge medicine tutor, last millennium
‘Of medicine, rowing, socializing, and relationships, many can do two things well, some can do three things well. It is very rare to manage all four.’
You will need to be extremely organized and make good use of your time in order to fit in medicine with other interests. It may be a good plan to get an idea of your workload and how you cope with it before committing to too many different activities. Bear in mind that many medical students have not had to apply themselves too onerously in order to achieve top marks at high school. It can be a shock at medical school to find that life is harder, that you are no longer top of the class, and there is no alternative to hours of bookwork. Anatomy, for example, cannot be deduced from native wit or basic principles, and instead requires diligent learning.
If you know from the outset that you are committed to playing football at university level, and that this will require a full day off midweek to travel to games, it is worth being upfront with your tutors from the start. You may be able to swap tutorial groups or practical classes in order to accommodate this. In addition, being honest will be more highly regarded than simply failing to turn up. Remember that students must sign in for many lectures and practicals and that your absence may be noted. If you really do have to miss sessions, approach a friend in advance and ask them to take notes on your behalf and spend time filling you in afterwards. Offer something in return. If you do not understand the content you have missed, ask your tutor to spend some time going over it. Continuing to meet deadlines and performing well in written work will be evidence that you are not neglecting your studies and may make others more inclined to be helpful towards you.
Taking part in university-wide activities means that your colleagues will study subjects other than medicine. They may not appreciate your workload or inflexible timetable, nor be willing to accommodate it. Taking part in medical school societies has the advantage that everyone else does what you do. Sharing an interest can spending quality time with the next best thing to family, fostering long-term friendships, becoming less homesick, and creating a sense of belonging away from home.
If you do find yourself missing hours of study during the week in order to play the piano, you may need to sacrifice your free time at the weekend in order to catch up. What you should not neglect, however, is good-quality sleep, exercise, diet, and your well-being! Remember to find joy in the things that you decide to invest time into. You only have one shot at going to medical school so make the most of your time inside and outside your studies. You may be surprised at finding out your hidden interests and passions but you will only be able to recognize them if you put yourself out there.
You may think that you are the only person with an interest in early medieval music or the plays of Christopher Marlowe. This is unlikely to be the case. Why not start your own society? Using social media it is easy to make contacts, and you may be able to get funding from the university or medical school. Showing such initiative does not harm your CV either as it demonstrates your multiple interests, wholesome personality, leadership, and teamwork skills. Society members may not study the same subject but your shared interests may just spark an ever-lasting friendship with people from all walks of life.
Many students do voluntary work, particularly in preparation for medical school applications. Your clinical experience may expose you to particular areas worthy of your time such as care homes or hospices. Working with the homeless offers valuable experience with those with substance misuse/addictions.
There are ample opportunities advertised by the volunteering centres at your university and in town. There will always be something for you to do and somewhere to make a positive influence. Volunteering and helping out has also been demonstrated to help with mild depression and offering a sense of personal satisfaction, purpose, and identity. Medical students tend to be altruistic and righteous but many feel disheartened by believing that they can only help others after graduating as a doctor. ‘Caring’ skills are extremely valuable and until recently neglected by most courses. Remember though that being a successful doctor will make you a valuable member of society and you should prioritize your studies.
There will be a number of small grants and prizes available through medical school or university to support those performing in extracurricular activities at a high level, e.g. to cover the cost of music tuition or sports training camps. A successful applicant is likely to be someone who also performs well academically.
Remember that medical students represent the profession, even in non-medical environments. Medical practitioners should not allow their own political, moral, or religious beliefs to influence patient care. This is not to say that you should not be politically or spiritually active in your free time, but use common sense in avoiding potential conflicts.
You should interact with others online in the same way that you would face to face and remember that you are representing the medical profession even when ‘off duty’. Read the GMC guidance on social media (
www.gmc-uk.org/guidance/ethical_guidance/21186.asp).
Remember also to use discretion when deciding which photos of you may be seen by others.
Familiarize yourself with the GMC standards expected of medical students ( www.gmc-uk.org/education/undergraduate/professional_behaviour.asp).
Excessive alcohol and recreational drug use are not uncommon among medical students. Remember, however, that these are fitness to practise issues, even before you have qualified. GMC guidance for undergraduates refers explicitly to:
• alcohol use that impairs work or affects the working environment
• dealing, possession, or use of recreational drugs, even if there are no legal proceedings.
There is also clear guidance on the help available to those with true substance addiction ( www.gmc-uk.org/education/undergraduate/26665.asp) with responsibilities both on the part of the medical school and the student. Most undergraduate recreational drug use, however, is not in the context of addiction so use common sense. If you have concerns about substance misuse by a fellow student, you should share them.
‘Social’ drinking is an important part of undergraduate life for many people, a chance to relax after hard work and have fun. Moderate drinking is a perfectly acceptable behaviour in both medical students and doctors. However, you need to be aware of the associated issues (habit forming or high-risk behaviours, liver damage, 
risk of some cancers, cardiovascular risk, cognitive impairment). Remain mindful of Department of Health guidance: do not regularly exceed 2–3 units/day for both sexes (i.e. 1 bottle of wine = 10 units, 1 pint of beer = 2.5–3 units).
Once an integral part of university life, they are increasingly falling out of favour, particularly with the authorities. This is one of the more ugly faces of undergraduate socializing, encouraging binge drinking, dangerous and disrespectful behaviour, and peer pressure to misbehave. Again, remember that you are representing the medical profession—hard to do when you are 12 pints down, naked, and strapped around a tree because your friends find it hilarious.
The use of all recreational drugs is taken very seriously by medical schools and the GMC. Do not take the risk! If you have a genuine addiction, be brave, be honest with yourself, imagine your career ahead of you spanning four decades, and seek help early. Your university’s occupational health department can offer you advice and refer you to an appropriate specialist counsellor.
Doctors are allowed to smoke. Most hospitals are smoke free so it will be a struggle to nip out for a quick one during a 12-hour shift. Cigarette smoke is very pervasive and the smell will stay on your breath and in your hair and clothes when seeing patients. Imagine telling a non-smoker they have lung cancer when you smell of Benson and Hedges. This harmful habit is often started early in life (e.g. at university) and is very hard to break. The addiction is more powerful than years of studying blackened lungs in pathology or atheromatous vessels. The sensible approach is never to start.
In the fitness to practise declaration, medical students/doctors must list any driving offences (other than where a fixed penalty notice has been accepted and paid). Drink driving is likely to result in a fitness to practise hearing.
Even as a medical student you have a responsibility towards promoting public health and safe behaviour. For this reason you should set an example in your sex life, and encourage others to do the same. There are multiple options including barrier contraception, devices, and medicines to avoid STIs as well as unwanted pregnancies. More information is available from your GP or the university occupational health department.
Logbooks form a proof of procedural/surgical experience and they are essential, particularly if you plan on pursuing a surgical specialty. When you eventually apply for postgraduate clinical posts (medical or surgical), you will be required to prove the statements you make. Systematic recording of surgical procedures is a requirement of the Intercollegiate Surgical Curriculum Programme (ISCP). A logbook of surgical experience may be of interest to your clinical/educational supervisors when your progress is assessed during medical school. later, surgical logbooks are important for annual appraisals of training (ARCPs), revalidation, and continuing professional development.
It is important to record the following details of all procedures:
• Hospital number (no identifiable patient details otherwise).
• PS: primary surgeon, supervised.
You should enter key details about the operation itself: was there anything that describes the complexity of the procedure, or any complications? This will add to the demonstration of your surgical experience.
Traditionally, logbooks were paper based and entered manually, and later, on a spreadsheet. Electronic, online logbooks are now available which have many advantages:
• Automatic backup of data (so that you cannot lose it).
• Tabulation of surgical numbers.
• Surgical progress over time.
• Built-in audit facility: automated surgical outcome data.
There is a pan-surgical web-based logbook available for use by medical students, administrated by the Royal College of Surgeons Edinburgh ( www.elogbook.org/logbookclient/registration or www.surgeon-logbook.com).
Start today! Record all surgical procedures you are involved in, using an online surgical logbook. This will establish good habits early, and allow cases you contribute to as a medical student to form part of your career record.
Implicit in medicine is the concept of life-long learning. Reflective practice is one method that assists with this continuous cycle of learning. It provides a way of breaking down experiences, both clinical and non-clinical, to help evaluate one’s own practice and to identify learning outcomes as well as areas for development and improvement. You will experience many things throughout your career, some more significant than others. Reflecting on your experiences will also assist you in developing coping mechanisms and prepare you for recurrences.
Reflective practice is widely used during undergraduate and postgraduate training programmes as experiential learning. It is found at all levels from student to consultant level and is becoming increasingly important in the process of revalidation. In addition to traditional modes of assessment, reflective practice is now being incorporated into training programme assessments as a way of demonstrating particular competencies and to prove personal professional development. Exams and assessments aside, it can be used to formalize your thoughts, establish your own strengths and weaknesses, and therefore adapt your individual actions and learning needs.
We all reflect daily. Any situation which makes you think after the event has occurred can be included in reflective practice. Some situations may be more pertinent and meaningful to you than others. There are situations which make you feel good or pleased, those which make you feel upset or worried, those which analyse a significant event, those which demonstrate a void in your knowledge, and those which make you feel improvements or changes are possible. These are just a few examples of scenarios which can form the basis of a reflective piece.
Reflective practice can be done individually or with your peers, other colleagues, or your supervisors. It can take the form of case-based discussions or informal conversations. It can also be done more formally in writing which often helps cement thoughts and feelings. It is useful to practise writing these from an early stage and to find your own preferred structure. Below are some subheadings and questions (with example answers) which you may want to consider during reflective practice:
• What is this reflection focusing on?
• Why do you want to talk/write about this situation?
Example: ‘Good communication with patients is vital. This reflection focuses on the importance of tailoring an explanation of a diagnosis to a patient.’
Keep this concise and be sure to anonymize any patient information.
Example: ‘I saw an elderly patient who was hard of hearing in clinic. I needed to explain their diagnosis of osteoarthritis so that they would understand the condition and management options.’
• What did you find difficult?
• What were your thought processes?
Example: ‘I found it easy to describe the condition clearly and concisely without using medical jargon. I used a plastic model of a knee joint as a visual aid to help with this. The patient understood and was grateful for the explanation I provided. This made me feel pleased. I found it more difficult to explain a clear management plan as there were still blood tests and radiographs pending. I feel I could have appeared more confident in my delivery of the options available and could have simplified the plan.’
Example: ‘I learned that it is important to communicate and tailor the explanation of a condition to each patient as an individual. In this situation, I used a visual aid in the form of a model to help with the explanation as the patient was hard of hearing. Others may prefer all the specific details and figures of their condition while others may prefer just an outline. This is particularly important as I will be seeing patients of all ages and backgrounds.’
• Is there anything you would do differently?
• What are your further learning needs?
• Why are these important/relevant?
• How and when will you complete the learning cycle?
Example: ‘Giving leaflets to patients or signposting them to further resources and information is always good practice and I could have given this patient a leaflet to take home at the end of the consultation. I would also like to improve my confidence in discussing the management options with patients to help gain their trust. I understand that this may come with time but I could also address this learning need by asking my senior or supervisor to observe me during my next consultation so that they can give me feedback on my performance.’
BMJ: www.bmj.com/content/336/7648/827.
If you are fortunate enough to have a clear career ambition, this will not be a difficult choice. You may score valuable CV points with a short extracurricular project which displays your enthusiasm for a given specialty. If you are in the undecided majority, you may be guided instead by a particular doctor with whom you have developed a good rapport, or a specific clinical or scientific question you wish to answer. You should bear in mind the following points:
You will need a mentor to oversee and direct your work. If you have developed a good relationship with a doctor on the wards, do not be afraid to ask if they have any suitable projects. Alternatively, they may be able to recommend a colleague.
Remember that extracurricular projects must not affect your performance in mandatory courses and you should only commit to something you can do in your spare time before the deadline. Be realistic; you will not be able to access the case records of 5000 patients or master a complicated bioinformatics programme without a dedicated full-time stint.
In many instances you may find your most valuable assets are spare time and enthusiasm, and most projects will not require any particular skills at the outset. However, if you have a passion for computer programming or database management you should make this known and tailor the project towards these areas.
You may well be asked at interview what you have learned from a given project. Be prepared to discuss specifics (such as the complication rate following ileal conduit formation or the cost–benefit analysis of IV compared to PO paracetamol), as well as more generic or transferrable skills such as scientific writing, critical analysis of literature, and time management.
You should have a clear aim of what you wish to get out of an extracurricular project. Some supervisors will have a dataset they wish to gather, or want to know an answer to a specific question; however, these aims may not be of immediate benefit to you. Make sure that you have something to show for your efforts, such as authorship of a paper, a poster presentation, or a talk at a local meeting.
• A clinical audit that ‘closes the loop’.
• Data-gathering exercise. This could be clinical (e.g. the incidence of herpes zoster among rheumatology patients treated with rituximab or a case series of children with nephroblastoma), or subjective (e.g. a patient satisfaction survey following cataract surgery).
• Clinical protocol, e.g. the hospital-wide guidance on how to manage diabetic ketoacidosis or outpatient paracentesis.
• Quality improvement. Are there any aspects in which your department could perform better and how could this be achieved? What supporting data is required?
• Service review, e.g. the impact of a breathlessness intervention service on readmissions in patients with COPD.
• Literature review or meta-analysis (e.g. what is the evidence in support of a particular intervention)?
• Book/chapter writing. Many doctors are involved in writing textbooks or handbooks and would be only too pleased to delegate some of this.
• A focused basic science project.
• Educational video, e.g. how to break bad news, or a clinical demonstration of knee examinations.
• Social media, such as a website or forum to discuss issues relevant to medical students or share information. Be aware of GMC guidance for responsible use of social media ( www.gmc-uk.org/Doctors__use_of_social_media.pdf_51448306.pdf).
• A patient information leaflet (e.g. ‘What you need to know about eczema’).
Limited funding may be available via:
• individual specialty organizations ( www.money4medstudents.org/bursaries-and-grants)
• your college (where applicable)
• your supervisor (if they have a research grant of their own).
Clinical audit is a tool used to evaluate performance against an existing standard or criteria (e.g. NICE guidelines), and is an important part of quality improvement and management. Most clinical departments will be required to audit a number of outcome measures on a regular basis. Audits invariably require a degree of data collection, and as a result medical student involvement is both encouraged and mutually beneficial.
A clinical audit should:
• select an area to evaluate (e.g. waiting time for hip replacement surgery)
• compare current performance against objective guidelines (e.g. 18-week target)
• identify areas for improvement
• suggest and implement changes to facilitate this (such as a streamlined referral pathway)
• re-audit the same measure following these changes to show any outcome improvement.
This is known as the audit cycle, and the aim of any audit should be to ‘close the loop’. (See Fig. 54.1)
Fig. 54.1 The audit cycle. Reproduced from http://www.nature.com/bdj/journal/v217/n7/images/sj.bdj.2014.861-f1.jpg.
Identify a department in which you have a particular interest, or colleagues with whom you have established a good rapport. A good place to start would be to ask the junior doctors in that team; some of them may already be involved in clinical audit and would be glad to supervise you and happy for your help. Alternatively, email the consultant in charge of departmental audits and management issues. Ask for a suitable measure to audit; many departments will have a long list of outstanding projects. Choose one that will be manageable for you in the time available. Be very clear on what it is that you are auditing before you start.
Identify the standards against which you will be comparing your data (usually NICE guidelines or similar). Audits are part of clinical governance and some are more political than others. Some audits are related to funding and will always be given more priority. If you are given a re-audit that has been done for several cycles, then it is probably best to request the previous reports and presentations to ensure that you are conducting the audit correctly and in a similar fashion.
Take plenty of time at the outset to decide what data you need to collect. You will need a list of patients for inclusion; this data is likely to be provided by a data manager, the audit department, or secretaries. You then need to decide what pieces of information you need to collect for each patient (demographics, date of referral, date of surgery, GP surgery, complications, etc.). There is nothing more frustrating than finding something vital has been missed and having to access 50 sets of notes again to find it. Create a pro forma template on which you will collect data and ask someone to check it before you start.
Be aware of the rules regarding data protection: make sure to check which computers you should use, ask for an encrypted data stick, and know what (anonymized) data may be taken outside of the hospital.
You should define your inclusion criteria, show how many patients were identified, how many notes were accessed, and demographics of the data set. Your main outcome is the performance against the objective measure (i.e. 85% of patients had hip replacement surgery within 18 weeks of referral). You should then identify reasons why 15% of patients did not receive treatment in this time (cancelled by patient, staff shortage, administrative hurdles in referral process, etc.).
It may be beyond your remit to change working practices within a department! However, at this point in the audit cycle, changes should be implemented to improve performance within a given measure, e.g. more space allocated in orthopaedic theatres or a computerized referral process.
After changes have been implemented, the data collection should be repeated after an appropriate interval (usually 3-6 months) to evaluate any improvement. Realistically you are unlikely to be involved throughout the entirety of the audit cycle and someone else may re-audit.
It is very useful for your CV to show involvement in a clinical audit. You may wish to submit a formal report of your findings to the department, or even present your data at a clinical directorate meeting. Being able to show evidence of involvement in quality improvement activities such as audit will stand you in good stead.
These are very similar to auditing with the main difference of reviewing your data collection, sampling a smaller population, and implementing changes as well as reviewing its impact far more frequently (e.g. weekly).
Audits and research are not the same thing but both contribute to clinical governance. Audits look at whether your hospital met set and defined standards in terms of clinical practice. These standards may have been set by local, regional, or national bodies. Conversely, research looks for new knowledge, discoveries, and inventions. See Table 54.1 for other differences.
Table 54.1 Audit vs research
| Audit | Research |
| Measures whether targets are being met | Creating new information, sometimes with very little pre-existing knowledge |
| Set against defined standards | Guided by a hypothesis/theory |
| Retrospective | Either retrospective or prospective |
| Does not involve live subjects | May include live subjects (e.g. animals or human) |
| Ethical approval not required | Ethical approval required if human or animal subjects involved |
Further reading
NHS England. Clinical Audit: https://www.england.nhs.uk/ourwork/qual-clin-lead/clinaudit/.
Royal College of Obstetrics & Gynaecology. Understanding Audit. Clinical Guideline Advice No. 5. www.rcog.org.uk/globalassets/documents/guidelines/clinical-governance-advice/clingov5understandingaudit2003.pdf.
Hexter AT. How to Conduct a Clinical Audit: A Guide for Medical Students. National AMR. www.southampton.ac.uk/sias/resources/howtoseries/howtoclinicalaudit.page.
When starting out at medical school it is easy to become awestruck by how much there is to ‘know’. However, as one progresses, it becomes apparent that what is unknown is an equally daunting prospect. Medicine is full of controversies and uncertainties in the management of even the most common conditions.
It is medical research that pushes forward these limits of our understanding, with the aim in doing so of improving patient care. This is acknowledged directly by the GMC which states: ‘Research involving people directly or indirectly is vital in improving care and reducing uncertainty for patients now and in the future, and improving the health of the population as a whole.’
Many students will experience research as part of their medical degree, and a proportion will go on to become leading academics of the future. While those that follow a focused research career are the minority, it is becoming increasingly recognized that all doctors should be able to engage with research, for instance, facilitating patients of theirs who wish to participate in studies.
Research is about discovering new concepts. Both the processes of research and the potential results may have adverse consequences (e.g. an adverse reaction to a drug in a trial, or finding the Huntington disease mutation in a sequencing study). As a result, there are strict ethical and procedural frameworks in place to minimize risks. While certain ‘Eureka!’ moments and individuals have become ingrained in our collective psyche—the discovery of the double helix, or penicillin—the reality is that the majority of the development of new knowledge is the sequential result of persistent hard work, often among teams of collaborators.
There is a quantitative hierarchy of levels of evidence to signify the quality of the study (Fig. 54.2). For instance, the data is more likely to be applicable to your practice if a new treatment has been demonstrated to be more effective against the current gold standard treatment in a randomized controlled trial with patients (level 1) as opposed to one expert claiming it is without any testing (level 5 opinion). Conducting research that has a high level of evidence will also attract more positive attention, funding, and job opportunities in research.
Fig. 54.2 Levels of clinical evidence. Reproduced from wikimedia under the Creative Commons Attribution-Share Alike 4.0 International license.
Medical research and the practice of evidence-based medicine are intrinsically linked. Evidence-based medicine utilizes the outputs of research to enable decisions to be made on the most robust available evidence. In contrast, it is medical research that generates this evidence. It is not uncommon for the conclusion of systematic reviews to highlight ‘more research is needed’.
Audit and service evaluations are performance measures and while they often use overlapping methodologies with research, they do not generally have the same risk of adverse events.
A range of opportunities are now available to undertake and get involved with medical research, many of which are part of formal ‘academic programmes’. While such programmes offer great opportunities and structure they are not the only way. Alternative schemes to that of England are available in the devolved nations:
• National Institute for Health Research: www.nihrtcc.nhs.uk/intetacatrain.
• Wales Clinical Academic Track WCAT: www.walesdeanerg.org/index.php/wcat.html.
• Academic Training Northern Ireland Medical & Dental Training Agency: www.nimtda.gov.uk/speciality-training/information-for-speciality-trainees/spec-academic/.
• Scottish Academic Training (SCREDS): www.nes.scot.nhs.uk/education-and-training/by-discipline/medicine/specialty-training/scottish-academic-training-(screds).aspx.
Some students may know they wish to pursue medical research from an early stage in medical school; others, however, only begin to consider it as they come close to or become consultants. How and when you choose to undertake research is an individual matter influenced by experience, opportunities, luck, and personal circumstances.
Many medical schools offer the opportunity to intercalate a Bachelor’s research degree (usually a BSc) during which students complete a specific research project and study a specific area of science.
A few medical schools now also offer the opportunity to combine a PhD with medical training as part of an MB PhD programme. It is also often frequently possible to pause medical training (e.g. between preclinical and clinical years), to undertake further research as a stand-alone degree (e.g. PhD). Sometimes, depending on the opportunities available at the medical school, a BSc may be upgraded to a Master’s (MSc) which requires a longer research period and dissertation. However, Oxbridge students have their intercalated degree automatically upgraded to a Master of Arts (MA) upon graduating. It is not infrequent that graduate entries to medical school have considerable medical research experience. This time will not only teach you valuable skills about research but will offer a plethora of opportunities for you to submit your project to journals for publication and international conference presentations.
A number of Academic Foundation Programmes offer a 4-month research rotation as part of the 2-year Foundation Programme, with the intention of giving trainees more experience of research.
These posts incorporate both clinical and research training (usually a ratio of 75% to 25%) and give trainees the opportunity to develop research ideas and skills to support an application for a research training fellowship or an application for a place on an educational programme ( a higher degree).
The PhD is seen as the key foundation for an academic career. PhDs typically take around 3 years to complete during which students undertake rigorous scientific research which they then submit as a thesis. A number of specific fellowship schemes are available for doctors (e.g. MRC, Wellcome, and NIHR Clinical Research Fellowships).
Similar to a PhD, MDs require the completion of a detailed research thesis. These are often more clinically orientated and may be completed in 2 years, sometimes alongside clinical training. PhDs are increasingly favoured over MDs for those wishing to pursue a research career.
A huge range of Master’s programmes are available for doctor to enable further research experience. Many are orientated towards part-time or distance learning facilitating learning alongside formal training programmes. Some specialist training programmes themselves incorporate a Master’s degree.
Other options include a 1-year MRes (Master of Research) which is a Master’s degree that places more weighting on research as opposed to attending lectures. MPhil (Master of Philosophy) is considered as half of a PhD and usually lasts for 1 year.
Similar to ACFs but at more senior training grades, and usually post PhD these programmes offer part clinical and part research training.
A range of fellowship opportunities are available to enable doctors to establish themselves as academic leaders. In general, research-active clinicians are predominantly employed by universities, while holding honorary contracts with NHS providers.
A range of stand-alone fellowships variably including research are often available. In some cases these may be linked with specific studies (e.g. in supporting a clinical trial).
The term given to doctors who spend time in research, outside of their specialist training programme. This may be to complete a personal research fellowship, but it may be for independently arranged research experience to gain more experience prior to returning to clinical training or applying more formally for other schemes and awards, such as a PhD. (See Fig. 54.3.)
Fig. 54.3 Overview of academic posts in the UK. Reproduced with permission from NIHR, www.ukcrc.org.
Just as careers in medicine can be very diverse, so can medical research. Different types of research may suit different types of individuals. Consequently, students should not be put off by a single bad experience (e.g. ‘I didn’t enjoy my BSc project in X’s lab, so I won’t enjoy a research job’).
For many, the image of medical research is a researcher wearing a white coat, sitting by a bench, pipette in hand. While laboratory research does make up a considerable proportion of medical research, it is only one of several areas. Within laboratory research diverse ranges of techniques may be used, making even this extremely variable. As technologies develop, laboratory scientists increasingly require a range of skills from bench work to advanced computing. Bear in mind that this type of research usually takes a much longer time until completion, compared to clinical projects. In return, your work is likely to be published in a journal with a higher impact factor than clinically orientated journals.
This involves research which interacts directly with patients and can range from drug trials and development of new devices, to qualitative assessments of patient experiences.
• Epidemiological studies: often look at the bigger picture studying the health of populations.
• Translational research: is a popular term at the moment and applies to the application or ‘translation’ of laboratory discoveries into clinic. As technologies facilitate speeds of analysis, this process is becoming more two way, so-called ‘bench to bedside and back again’ medicine and research.
• Other types of research: include medical education research, health systems, and health technology research.
(See 
Chapter 5.) Medical research is expensive (a UK clinical trial costs ~£9000 to recruit one patient, so a trial powered to included 300 patients would cost ~£2.7 million). Research involves not just the direct costs of the experiments (e.g. reagents) but also salaries of researchers, institutional overheads, insurance, university fees, etc. As a medical student undertaking a BSc, many of these will be provided for by the supervisors’ funding; however, when applying for fellowships (e.g. for PhD), it is important to find out what is and is not covered (e.g. fees).
Funding comes from one of three main areas:
The government funds research through three main streams: the Medical Research Council, the National Institute for Health Research (NIHR, part of the NHS), and directly from the Department of Health.
The Wellcome Trust is the UK’s largest non-governmental funding of scientific research. National (e.g. Cancer Research UK) and local (e.g. Great Ormond Street Charity) medical charities also provide a significant proportion of funding and have a range of schemes supporting medical students/doctors in training to undertake research.
The majority of drug trials will be funded by pharmaceutical companies. In addition, various companies also sponsor research and career development through a range of schemes and opportunities for funding research among doctors and medical students (e.g. funding PhD research training fellowships).
In addition for the medical need for research there are lots of other reasons for wanting to undertake or get involved with research and pursuing a research career. Some do it because of sincere passion, some do it to jump through hoops in an attempt to improve job prospects, and some do it out of sheer curiosity.
Discovering something new, particularly when it has the potential to improve lives, is a pleasurable experience on to which some researchers become hooked. There is a sense of achievement and an adrenaline rush when your hard work has been accepted for publication and embraced by your peers all over the world. Though ground-breaking advances may be rare, even smaller contributions in your field of expertise can carry with them a strong sense of satisfaction.
Research requires a range of skills, some distinct (e.g. certain methodologies), but many which complement and overlap with those needed to be a good doctor. Like medicine, successful research requires good teamwork, time management, and leadership/management skills. Working in a research environment is often a great time to develop and refine these skills outside the traditional hierarchies of clinical practice.
Researchers often have a degree of autonomy and flexibility in managing their workload which is distinct, and often envied by pure clinicians. Similarly, there are many opportunities to network and travel nationally and internationally. Undertaking medical research also enables links and interactions with a wide range of individuals and experts in a range of disciplines and areas, which in itself is often very rewarding.
Undertaking research simply to ‘fill a box’ on an application form is not a good reason; however, research experience itself will often help in applications for both clinical and non-clinical jobs.
Research is rarely straightforward and when pushing the boundaries of knowledge, a number of challenges and obstacles may arise and these may include:
Large volumes of often necessary red tape may distract you from the research itself. This is often, but not always, important for safeguarding patients and public.
You are expected to conduct your research ethically as per the guidelines published in Good Practice in Research by the GMC.1 If using live subjects, whether animals or patients, you must seek permission to conduct the study at your centre from the local ethics committee. Each university, medical school, and hospital ought to have their own ethics committee who tend to meet up once a month to discuss research methodologies. The time to approval may take weeks to months and you will be likely to alter your methodology several times during the process. Filling out the application form can sometimes take hours and days but it is essential to be transparent, ethical, and uphold patient safety/animal rights at all times.
Clinicians tend to get used to a fast turnaround of tests (e.g. FBC) but many research techniques, particularly if novel, are often less well refined, take longer, and require extensive optimization before results are generated. Unless the methodology for your research project has been validated in a prior study, you are more likely to have to develop a new methodology altogether since your research is novel. There is no guarantee that your methodology will be flawless and problems may only be noticed down the line, which consumes much time, money, manpower, and resources.
Research is a competitive environment and the difference between being ‘first’ and just behind in making a discovery can be profound. Much like countries at war, the same mentality is sometimes observed between research departments and universities. While many researchers are becoming more open to the idea of collaboration to overcome resource limitations, many are still sceptical and would rather not share the credit with a competing institution.
For those considering developing a research career there are a number of additional challenges to be faced. Researchers need to maintain their funding and may have less secure positions. Salaries vary and there are full-time research positions available but most medical researchers are also practising clinicians. It is after all the clinicians who are able to identify a problem within healthcare or patient management that drives the need for solutions through research.
There is only so much information a research project can yield before more resources, staffing, and costly technology become necessary to advance the study. There have been many cases where research studies will suddenly halt due to a lack of funding. The options are to then either apply for further funding and delay the end date of the study or publish whatever data you have managed to collect so far.
If your research involves animal models or patient participation, then this may become a rate-limiting step to obtaining results. You are required to obtain informed consent (both verbal and written) from patients who have the right to drop out of the study at any time. Animal models may not be able to consent but you are required to undergo formal training into their appropriate treatment and some models are genetically modified that may issues such as costs and availability.
There are five levels of evidence with one being the highest level.2 Research departments are under tremendous pressure to churn out high-quality studies with a high level of evidence in order to build a reputation, research profile, and obtain more funding to propel further and larger studies. You may be asked to fill in a research grant proposal3 to obtain funding.
This is a term for a systematic error which deviates from a true finding. For instance, the researcher may influence the results to favour a finding, albeit incorrect. There may also be bias with respect to choosing your study cohort (rather than achieving true randomization), incorrect data collection and interpretation, patients forgetting personal details when interviewed, etc. Bias ought to be unexpected and put down to the ‘human factor’ as opposed to being intentional. It should also be accounted for in publications.
1. General Medical Council. Good Practice in Research: www.gmc-uk.org/guidance/ethical_guidance/5992.asp.
2. Oxford Centre for Evidence-based Medicine. Levels of Evidence (March 2009): www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009.
3. The Writing Center, University of North Carolina at Chapel Hill. Grant Proposals: writingcenter.unc.edu/handouts/grant-proposals-or-give-me-the-money.
There are now numerous documents, including the ‘Gold Guide’, outlining generic research competencies for different posts. Generally these include the following:
Before looking for something ‘new’, understand what is already known. This includes a detailed search of the existing literature and a critical review of what is published.
The key to the majority of research is testing a hypothesis.
Often key to interpreting and designing studies is a good understanding of medical statistics.
Sustaining funding is crucial for any research to progress.
Such as applying for ethical approval, ensuring the relevant laws and regulations (e.g. Animal [Scientific Procedures] Act, Human Tissue Act or Data Protection Act) are adhered to.
‘Knowledge is power’, attributed to Francis Bacon, highlights the importance of understanding the consequence of research discoveries.
If you do not publish it, from the perspective of the rest of the world, it has not been done. There is an inherent obligation to publish the results of studies and this in itself requires a specialist set of skills. You are expected to communicate a principal message as succinctly and effectively. As the old idiom goes: ‘publish or perish’.
Researchers are expected to be good at presenting their work in presentations and sharing their knowledge through teaching and conferences. It is an art to be able to convey your principal message within minutes to an audience with varying skills and experiences.
Many discoveries are the result of collaborations and, as with most careers, networking skills are often key to this.
Research involving human subjects carries with it potential for harm. Unfortunately, there are many examples in history where medical research has caused more harm than good. Consequently, a number of guidelines, regulatory procedures, and laws have been developed to assess and appropriately manage such risks, two of which are:
A set of ethical principles for human research, first published by the World Medical Association in 1964 and last updated in 2013. This was developed from the Nuremberg Code (1946), the first set of internationally agreed guidelines of research involving people that was produced following the unethical experiments carried out by Nazi doctors.
Good Clinical Practice (GCP; www.gov.uk/guidance/good-clinical-practice-for-clinical-trials) is a set of internationally recognized ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.
These include the Data Protection Act and the Human Tissue Act, which regulates the use of human tissues in research and the Animal (Scientific Procedures) Act, which regulates scientific experimentation using animals. Some core principles outlined by the GMC can be seen in Box 54.1.
Box 54.1 Core principles of most guidelines (GMC guidelines)
• Scientific validity of research.
A key component to ensuring research fulfils these principles is for it to be assessed by an independent ethical review committee. NHS research is reviewed by the NHS Health Research Authority and can be accessed through a centralized Integrated Research Application System (IRAS; www.myresearchproject.org.uk/).
This refers to the structures which ensure that research is carried out to the ethical and other standards required, for instance, abiding by the Human Tissue Act.
When wanting to get involved in research there are a number of questions to ask yourself:
Is it to find out more, is it ‘for the CV’, is it because of a specific patient?
Do you want a taster, a publication, and/or to learn a method?
Are you looking for a full project for a degree, are you looking for a summer vacation project, or something to do in the evenings/weekends? Other opportunities include committing some of your time during your elective and special study module (SSM) towards research.
If you want to be a cardiologist, doing a project in neuroscience might not be the most appropriate for your long-term career aims.
If you get motion sick looking down a microscope or the thought of animal experiments turns your stomach then pick something else!
Different centres and universities have different expertise and different patient cohorts and so it is important to consider what is available where, and how that affects your choice. For instance, if you are interested in X disease of the left testis then you might need to move to a centre specializing in that condition.
Sometimes the best opportunities are not the ones you ‘plan’ for. If you hear of an opportunity, explore it, and then decide whether you think it is appropriate for you. Just because it is not your ‘ideal’ project, it does not mean it might not be excellent. These often turn out to be the best! Departments are always looking for keen students to train and help out with projects, whether that is recruiting participants or collecting data, you may initially find it difficult to make contact. The best solution is to send the departmental secretary an email with your intentions, interests, and CV. Other platforms include UROP (Undergraduate Research Opportunities Programme) whereby departments advertise research opportunities and are actively seeking students to help out.
(See Chapter 5.) In order to undertake research you will need someone with experience to guide and support you such as a supervisor. This should be someone who has expertise in your area of interest and who can also invest their time (or their team’s time) in supporting you.
The more people you talk to, the more options you have and the more you will get a sense of which project might work well with you. Just because they are considered a deity in their area does not mean that they will be the best choice for a supervisor. If they do not reply to you/find time to meet with you, they probably will not be able to invest in you as an individual, so do not feel discouraged and find someone else. There will always be someone to support you—your job is to find them.
Do not get disheartened if one fails or does not yield positive or expected results—another project might be different. It is sometimes worth having more than one strand to a project.
Much research is dictated by the available technology (e.g. next-generation sequencing), so it is important to keep up with advances. Increasingly, good computer skills are vital for good research and its presentation.
A mentor differs from a supervisor in that they are separate and independent from your day-to-day working.
At a junior level, applicants are assessed on their potential, so it is not essential to have publications, though it may help. Publications often take time to come through. Discuss with your supervisors how best to optimize your chance of publications. Yet, you must be prepared to hear that the study may not be ready for publication, may need more work before being published, and may not feature your contribution in the final publication.
Some people think they are not ‘clever enough’ to do research if they have not done any previous research at medical school. This is a fallacy. The most important thing is a good idea, good support, commitment, and enthusiasm. Everyone loves a good leader so you have the power to persuade others to share your vision. Much like any job, this is where you sell your skills, abilities, and ideas. If you can put this together, then anyone has a good chance of being successful.
A popular adage goes that the only bad research is unpublished research. While research offers medical students a number of transferrable skills that do not need a publication to validate them, you could be left with nothing concrete to show for hours of effort.
Another school of thought is that bad, incomplete, or unnecessary research is harmful or distracting to the field. In general, you should aim to finish each piece of research that you undertake with some form of report; this need not be a submission to a journal—in many cases the limited scope of your work would be better suited to an abstract, poster, or oral presentation.
Note the following guidance for publications to be awarded points in the Foundation Year application process:
• A maximum of 2 points are awarded for publications (compared to 5 for undergraduate/postgraduate degrees or 43 for medical school performance).
• You need to be a named author but not necessarily the first author.
• Publications under review or still in progress will not be considered.
• Publications must have a PubMed ID (PMID), and the link you include with the PMID must lead directly to evidence of your article with one click. This is relevant for example where your work is published as an abstract at a conference, and where one click will not lead directly to your own work. In this case, the publication will not be scored.
Your supervisor will advise on this. A good outcome would be if your work formed a part of a larger study already underway in the group, in which case your contribution may be acknowledged with ‘middle authorship’. Unless you have spent a significant period in research (i.e. a summer studentship or intercalated BSc), first authorship may not be realistic. Short, stand-alone projects may be more appropriately submitted to conference proceedings as poster or oral presentations. There may also be local opportunities to present your work (e.g. medical student fora or regional meetings). There is no harm in aiming high with the choice of journal. The comments of editors and reviewers can be extremely valuable in improving your submission for next time (though a thick skin is required!)
In science writing, one should assume that the audience will be scientists but not specialists in the field.
Most journals have very strict guidelines on word count, formatting, and sections to be included. This information is available via the relevant homepage under ‘Author instructions’. In general, a scientific paper should comprise the following sections:
1. Title and author information.
2. Abstract (usually 250–300-word summary).
6. Discussion (including limitations and future work).
9. Figures, tables, and legends (these are usually uploaded separately or featured at the end of your submission).
Often the source of much discussion, but your supervisor will decide upon the order of authors. Their academic affiliations should be attributed correctly, and a designated ‘corresponding author’ should be identified and contact details included. Elsewhere in the manuscript, one should include any conflicts of interest (e.g. funding which could be viewed to introduce bias) and each author’s specific contribution.
(See pp. 96–97.) This is the section that will be most widely read (and many editors will make a decision based on this) and available to everyone via PubMed. Hence it is important to make it punchy! In about 250 words, you should aim to introduce the field, and describe the context and importance of your work. You should then outline your research question and mention the methods used before summarizing your findings, your interpretation of them, and why they are important. The principal finding of your study will need to be peer reviewed by experts in the field and deemed worthy to compared to the existing medical literature.
This is often the hardest section to get right, and counterintuitively best left until last when you have a clear aim of the purpose and context of your work. A good introduction should introduce the non-specialist reader to your field, briefly summarizing the existing and relevant literature. You should then outline the gaps in existing knowledge, or current difficulties pursuing these investigations, and how you plan to address them.
Often placed towards the end of the manuscript, and more for reference than for reading from beginning to end. The aim here is to provide sufficient information that someone else could replicate your work and see similar results.
If, for example, your work involves a literature search, you should outline the search engine, the search terms, exclusion criteria, the date accessed, etc. Basic science work should include explicit information about reagents (e.g. manufacturer) and protocols. The statistical tests (e.g. paired student t-test) and software (e.g. SPSS, Microsoft Excel) used should be described. This is also the section where ethical approvals should be detailed.
Many readers will skip straight from the abstract to the results and figures. This should be broken down into manageable sections, each with a subtitle outlining the major content (e.g. ‘The lungs contain a diverse immune cell repertoire’ or ‘Demographics of study participants’). You should state the results in a factual way without too much interpretation/discussion at this stage.
This is the section where you are free to interpret your data and the insights they offer. You should outline the strengths of your methodology to support your findings, and similarly acknowledge any potential flaws or weaknesses. Finally, having introduced the field and the current position of research in the introduction, you should finish here by describing how things have changed in light of this piece of work and what further studies are required.
This consists of one paragraph with three to four sentences stating the purpose of your study and the principal findings. Many people who access your publication will be most interested in reading your conclusion at first glance before deciding to read the entire manuscript. You do not have to be too specific with conveying your findings within this section but you must offer the general gist succinctly.
This section is more important than a simple bibliography may seem. Many readers will be directed to other papers from your introduction. Referencing a paper in your manuscript constitutes a ‘citation’ and scientists monitor how many times their work is cited. In fact, it is in this way that scientific journals earn their impact factor; e.g. Nature has an impact factor of about 40, meaning that the articles published in it were cited on average 40 times in the last year.
There are different formats of citing references, which the journal in question will dictate. Software for storing, organizing, and formatting references will save you a lot of time and effort at this stage. Make sure you read the submission guidelines carefully since every journal has their unique formatting style for references.
The common options include Harvard (mentioning the author and year of publication within the main text) or Vancouver (chronologically numbering all references when first used in the main text). EndNote™, for instance, is a simple and popular program ( www.endnote.com).
Figures usually form the scientific nub of the paper (i.e. the concrete evidence of the work you have done and the raw data). Some thought should be given to making your figures look attractive, uncluttered, and easy to interpret. Consistency of formatting and appearance is also important. You will spend many painful hours moving boxes around a page before you achieve adequate figures! Some journals have preferred types of figures (e.g. dot plots rather than bar graphs which may ‘hide’ data). Figure legends should give an explicit description of the data shown in each figure, describing the symbols/formatting uses.
This is where the authors thank and describe contributions from other people who are not listed as authors. For example, John Brown gave valuable feedback on the manuscript, Sarah Smith gave reagents X and Y, and so on.
Virtually all manuscript submission now occurs electronically. Details and uploading facilities are available on the journal’s homepage.
Unfortunately, this is the most likely outcome for most submissions and you should be prepared for this. There is no room in journal editing for sentimentality or recognition of the huge amount of work involved in preparing a manuscript. Where possible, you should seek feedback from the editor or reviewers. A common response is that your work would be better suited to a more specialist (i.e. lower-impact factor) journal. Individual reviewers, usually experts in the field from all parts of the world, may offer more specific feedback, e.g. highlighting weaknesses in methodology or discrepancies in data interpretation. Although bruising, this objective and anonymous feedback is often extremely helpful and leads you to improve your manuscript before sending it elsewhere.
Most manuscripts are not accepted by the first journal to which they are submitted, and even then only after various revisions have been made. Prepare yourself for a lengthy and sometimes frustrating process, but do keep on trying! Once your work is accepted for publication, there is no other sense of satisfaction and pride like it.
Applications for junior doctor posts increasingly rely on standardized forms instead of face-to-face interviewing. Any outstanding achievements that you can add to your CV will help set you apart from other candidates. The current job application form does not award points for medical school prizes (although academic trainees may list them in the ‘Academic Achievements’ section). However, your referees will have access to this information and may use this in their appraisal of you. Also, subsequent job applications are likely to recognize medical school prizes.
This will vary considerably according to your medical school and you should consult your local intranet for details. However, a number of prizes (particularly those offered by individual specialty societies) are awarded on a national basis.
A number of prizes are awarded to students based on their performance in formal examinations, both at undergraduate and clinical school level. You do not apply as such, and the news will usually come as a pleasant surprise to you. Prizes such as these showcase your achievements compared to your entire academic year and as a result are rightly regarded as prestigious.
Many local and (inter)national meetings at which students and trainees present posters or oral presentations offer prizes for the best work. Such awards recognize the quality of the work presented, the manner in which it is presented, and the initiative required to undertake the project in the first place. Presenting your work in written or oral form should be the ultimate aim of any extracurricular projects you take on in medical school.
NB: the current Foundation Year application scheme no longer allocates points for presentations, no matter how prestigious ( www.foundationprogramme.nhs.uk/pages/home/how-to-apply)
Many medical schools offer prizes for the best elective reports, including the chance to present your work at hospital-wide meetings. A number of funding opportunities exist from specialist groups (e.g. the Renal Association or the Association of Anaesthetists), for students seeking to undertake their elective in these fields. Awards such as these are competitive and as a result are also considered as prizes.
A number of opportunities are available both locally and nationally to recognize excellence in a particular area. For example, your medical school may have an endowment to fund an annual essay competition in the field of Psychiatry or Paediatric Surgery. Prizes such as these require initiative and time to enter but may be less competitive than other, more widely publicized awards. Similar opportunities exist at a national level ( www.money4medstudents.org/competitions-and-awards).1
A number of bursaries are offered for summer studentships, usually to undertake a period of basic or clinical research within the UK. Like elective bursaries, these awards are competitive and are considered as a medical student prize. Useful sources of information:
• Wellcome Trust: www.wellcome.ac.uk/Funding/Biomedical-science/Funding-schemes/PhD-funding-and-undergraduate-opportunities/WTD004448.htm.
• Biochemical Society: www.biochemistry.org/Grants/SummerVacationStudentships.aspx.
• University College London: www.ucl.ac.uk/ich/education/vacation_studentships.
• Undergraduate Research Opportunities Programme (UROP): may be available at your university.
Medical students may receive awards to recognize their achievements and contributions to fields outside of medicine, e.g. sports, music, or voluntary work. While still very commendable, they are unlikely to carry as much weight as prizes awarded for excellence in medicine. However, referees may use this information in their account of you.
Reference
1. Maruthappu M, Sugand K (2013). Medical School: An Applicant’s Guide. Cardiff: Doctor’s Academy.
Critiquing papers is an essential skill as a scientist, researcher, and clinician since you can only be expected to provide optimal, judicious, and evidence-based care to your patients if you have reviewed the justification yourself. As part of your intercalated BSc written exams, you may be expected to conduct a critical appraisal of a well-known journal publication. To critique a paper is challenging since you ought to challenge everything, from the key messages addressed in the abstracts, the methodology, data collection and analysis, limitations, and inferences. This is what ultimately distinguishes between high- and low-quality research. A handy checklist for systematically reviewing any piece of research is listed in Table 54.2
Table 54.2 Checklist
| Title | |
| Is the title appropriate and clear? | □ |
| Is the article published in a reputable/high-impact factor journal? | □ |
| Are the authors well regarded in the field of study? | □ |
| Abstract | |
| Does the abstract provide a concise overview of the research? | □ |
| Does the abstract highlight the research question, as well as the method used to address it? | □ |
| Are the main findings provided as well as recommendations or conclusions? | □ |
| Introduction | |
| Is the literature review relevant, balanced, and up to date? | □ |
| Does the literature review/authors highlight a need for this current piece of research? | □ |
| Is a focused and relevant study question/aim expressed? | □ |
| Methods | |
| What type of study design was chosen? Is it the most suitable to answer the research question? | □ |
| Are there limitations/problems/bias with this study approach? | □ |
| Is the study sufficiently powered? Are the study subjects generalizable? | □ |
| Have ethical concerns been appropriately raised and addressed? | □ |
| Have the study methods been justified, and described in enough detail to allow replication? | □ |
| If the method is based on standard protocols, have adequate references been given? | □ |
| Have the statistical methods been specified, with a rational for the choice? Are they appropriate? | □ |
| Results | |
| Do the results make sense with regard to the study method used? | □ |
| Were the statistical analyses performed correctly? | □ |
| Have tables and figures been labelled clearly and appropriately (including legends)? | □ |
| Are they easy to interpret? Do they represent the data collected? | □ |
| Have any gaps in data gathering/processing been accounted for? | □ |
| Discussion/analysis | |
| Have the results obtained been interpreted objectively and appropriately? | □ |
| Are the results discussed in light of points raised in the literature review? | □ |
| Do the authors needlessly speculate or consistently refer to unpublished data? | □ |
| Were the results obtained statistically significant? Are they clinically/biologically so? | □ |
| Are study strengths as well as limitations discussed? | □ |
| Were the study objectives met (i.e. did they answer their research question)? If not, why? | □ |
| Have new insights or recommendations for practice been made based on this research? | □ |
| Have the authors highlighted suggestions for future research? | □ |
| Conclusion | |
| Has the key message(s) been summarized and succinctly relayed? | □ |
| Has there been an objective assessment of the study? | □ |
| References | |
| Are the papers cited appropriately? | □ |
| Do the authors cite their own publications needlessly? | □ |
| Have any conflicts of interest or financial disclosures been reported? | □ |
Further reading
Centre for Evidence Based Medicine, University of Oxford. Critical appraisal tools: www.cebm.net/critical-appraisal/
University College London. Critical appraisal of a journal article: www.ucl.ac.uk/ich/support-services/library/training-material/critical-appraisal
University of Cambridge. Critical appraisal resources: https://library.medschl.cam.ac.uk/research-support/critical-appraisal-resources/
Since 2003, it has been a GMC requirement that medical schools allocate one-quarter to one-third of course time to SSMs (also known as student selected components (SSCs)). There will normally be two or three SSM periods each academic year, lasting 4–8 weeks each. You will be able to choose from a list of standalone projects covering many different specialties and disciplines (noting that you may not get your first or indeed second choice). Usually a consultant or lecturer will oversee each SSM.
• Transferrable skills: SSMs encourage self-directed learning, independent thinking, and critical evaluation of data.
• Specialist skills: you may learn how to undertake a formal literature review, a database search, or master a laboratory technique.
• CV points: if you choose wisely and your project goes well, your work may culminate in a poster presentation or even in a journal publication.
• Beyond the curriculum: the clinical school schedule cannot cover every speciality in depth in 3 years. SSMs are a great opportunity to explore a specialist interest that is not covered elsewhere in the curriculum.
If you have a burning desire to specialize in plastic surgery or public health, the choice of a relevant project may be easy. For the majority of you, however, bear in mind the following:
• Supervision: look for a project that offers adequate but not excessive supervision. Laboratory projects, for example, will rely on someone to help you learn new techniques whereas literature reviews or audits will require you to be more independent.
• Output: what will you get out of this? A small but defined project offering a realistic goal such as a poster presentation or authorship on a paper or protocol may be more valuable to you than a more expansive or nebulous project.
• Developing career interests. if you don’t have a specialty in mind, SSMs are an opportunity to explore an area not fully covered elsewhere in the curriculum.
• Time frame: will you realistically achieve your goals in the given time? This should not interfere with your core studies.
• Skills: if you are IT literate, setting up a database of liver transplant patients may be just the SSM for you.
• Enjoy it: SSMs should give you freedom, both intellectually and from the rigid timetabling of clinical school. Although it sounds obvious, try to choose a project that will not feel like a slog.
