AANS Neurosurgeon | Volume 26, Number 2, 2017

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On the Meaning of Clinical Research for Aspiring Physician-scientists: A Medical Student Perspective

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“Professionally, I wish to become a neurosurgeon with the analytical skills needed to translate clinical observations into viable research questions and, ultimately, effective surgical solutions.”

I have polished and recycled this sentence through several personal statements, referenced it in conversation with mentors and invoked it during introspection about my career aspirations. The phrasing is a bit clumsy, it sounds plainly canned and the notion of ‘surgical solutions’ is vague  as such it is imperfect but I have always liked the way this sentence reads and the cadence it delivers.

Writing this as an early MS1, I imagined that the paradigm it assumed was straightforward (Fig. 1). Over time, I began to question if students at my level of training would even recognize this dogma if it stared them in the eye.  

I had an interesting experience in the operating room just prior to the winter holidays. My academic mentor had invited me to shadow a routine microvascular decompression for a patient with refractory trigeminal neuralgia. As the PGY-7 began to close-up, a PGY-2 entered the room bearing word of the emergency subdural hematoma evacuation being prepped next door. This was my first glimpse into trauma neurosurgery, and the patient, a comatose elderly man with profound thrombocytopenia, looked in dire straits. I wonder if he will live, I remember thinking.

Does wondering if a patient will survive really count as a ‘clinical observation?’
At the conclusion of the stressful operation, my mentor called me into his office to reflect on the day. As he critiqued my novice instrument tying, we spent time discussing whether certain comorbidities (e.g., hypertension, anemia, thrombocytopenia) dispose patients towards favorable versus unfavorable outcomes from subdural hematoma evacuation. I left the room with scribbled plans to explore this question using data from the National Surgical Quality Improvement Program (NSQIP) registry, curated by the American College of Surgeons (ACS).

Does an informal conversation and a sloppy page of notes really count as a ‘viable research question?’
Over the next few weeks, I extracted a sample of patients from the NSQIP database suitable for our question and aligned myself with classmates who could help make sense of it. With a background in computing, I wrote a simple algorithm that identified independent predictors of 30-day mortality among our sample, and we used these results to develop a scoring system capable of stratifying mortality risk based on preoperative clinical factors.

Do a few lines of code qualify as ‘analytical skills’? Does a mortality risk score based on fewer than 2,000 retrospective cases count as a ‘surgical solution’?
I am still learning what clinical research means to me as a second year medical student, and I continually question whether my work does justice to the aspirations I set as an early MS1. Even if this project did not provide all of the answers, I am grateful for the challenges that it presented, relationships that it nurtured, and lessons learned. Together with a team of colleagues, I took a question that arose in the operating room, designed a tractable study, wrote a simple analysis script and used the results to address a clinical shortcoming. That may not be much, but it feels like progress.

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