If Medical School is like an all you-can-eat-buffet, then clinical research must be dessert. There is always room even when your stomach claims to be full.

This Summer’s inaugural batch of medical student at UCLA came from all parts of the country - East Coast, Midwest, and Southern California - to work with Cecilia Canales, MD, MPH.  We presented our research during weekly meetings on all things related to Frailty: biomarkers, lung transplant outcomes, prehabilitation, extracorporeal membrane oxygenation (ECMO), frailty metrics, perioperative neurocognitive disorders (PND) and more. With activities like ultrasound workshops, simulation training, and grand rounds it was too easy to get inspired while the summer months melted away. 

I'm grateful for the opportunity to expand on my interest in the specialty and work with others that I would have otherwise never met if it weren’t for the UCLA Anesthesiology research team’s support (and patience!). Be sure to check out their September Newsletter for my short anecdote among new friends in the journey toward Anesthesiology.

As a medical student, it never feels like you have enough time. With an already packed schedule, the mere mention of research can either inspire curiosity or trigger a heavy sigh. One of our professors embraces an alternative mantra by stating: “what can I say? I love pain.”

Here are some discussion points that I offered during a meeting about my previous experience in clinical research:

No time, but I want to do Research: Keep an eye our for Quality Assurance/Quality Improvement (QA/QI) projects  that involve patient safety or efficiency. These usually require minimal IRB paperwork approval to get started. Keyword: Non-Human Subject Research (NHSR). Another option common for residents is medically challenging cases. The deadline for this submission is usually later Spring and tends to be more straightforward in terms of submission requirements.

Plenty of time - I want Research:  Get involved with an Expedited IRB approval already up and running such as a retrospective chart review (data collection/analysis) whenever possible. These often provide a strong foundation for prospective studies and can be completed in less than a year with the right team and motivation. Abstracts, poster presentations and manuscript publications are key deliverables for your time an effort but are not a guarantee. Focus on the gained experience, new skills and professional networking opportunities.

Citation manager - Mendeley:  This may seem random, but discovering this tool was truly a game changer when it comes to managing cited works for literature review, abstracts, IRBs, etc; It’s FREE unlike Endnote ($150) and integrates with Microsoft Word and web browsers rather seamlessly.

Research is a Team Effort: You hear this all the time because it’s true and everyone could use a reminder. Get acquainted with the administrative support - especially if you’d like to request a strong letter of recommendation. Principal Investigators may ask support staff for their input on interaction with medical students. 

What to do in a post-Step 1 Score World: This question comes up most often since the decision has been made to switch Step 1 to pass/fail in 2022. The advice I came across from Katherine Chretien, MD is to develop genuine interests (research, teaching, policy, community - or something else). Check out her book if you’re interested in the latest advice for medical students. Don’t worry, there’s plenty of figures, diagrams and summaries where every page is like an instagram post. Highly recommend! 

“Learn how to start an IV, perform chest compressions, suture, intubate and place a central line - but not necessarily in that order”. 

After a brief introduction, Resident Physicians Drs. S and G from UMKC provided a crash course presentation on key terminology and risk factors during airway management. Over time our group of ~25 students transitioned from gently poking at the mannequin heads to scissoring and scissoring finger and sweeping the rubber tongues with confidence. Mastering a task trainer is one thing, but we all agreed that it’s going to be a while before we attempting any techniques on a proper patient.

When a fourth year medical student offers to demonstrate some tips on ultrasound, just sign up for it and figure out the rest later.

I admit feeling unprepared when the presentation had board style questions about anatomy, physiology and pharmacology that we haven’t learned yet as a first year. But after some basic instructions on probe manipulation and how to adjust settings we split up into groups to learn about FAST exams, look at ultrasound training block models and attempt epidural/lumbar puncture models.

Dr. RB - A third year (CA-3) resident physician at Johns Hopkin's University spent some time to share his insights with the Anesthesia Club via Zoom. 

He first discussed some enjoyable aspects of Anesthesiology without using the words physiology or pharmacology. Patient safety and vigilance came to mind first. He related these components of the specialty to his experience as a lifeguard for several years. As an alumnus from Kansas City University's medical school (2019) he admitted being originally interested in emergency medicine. Since anesthesia was not a required rotation he knew little about it until later. When asked about experience with research he mentioned some involvement with Clinical Research at University of California, Irvine where he studied for undergrad. See below for a summary of this discussion:

Implications of Step 1 pass/fail: It's likely that step 2 exams will be more heavily considered than before. He also mentioned how his personal statements were slightly tuned to each program that he was applying to. He then went on to describe an average day/encounters that you might expect as an anesthesiologist such as doing preop assessments the night before with your attending position and recommended taking full advantage of time spent in the ICU.

Categorical vs. Advance programs for Residency: He was unaware of this as a first year medical student so don't feel overwhelmed if this topic is foreign. Take some time to Google the nuances of this subject when you have some spare time. Generally speaking, one has the internship year and residency training at the same location while the other may have you intern somewhere else first (likely moving twice). Most programs are categorical but again, Google it later.

Advice on residency interviews: Stand out in a way that is genuine to your personality and interests. He doesn't anticipate interviews going back to in person in the near future with the convenience of remote visits. He joked that he still owe's his parents for fronting flight expenses during interview season. Some background on his rotations: the sub internship at university of Texas Houston, University of California Irvine, UMKC (ICU rotation). His general general advice simple when approaching programs: be kind and respectful.

Fellowship specialty training: Fellowships are a one year commitment that you can apply for after anesthesiology residency. These sub-specialties can include cardiac, obstetric, regional, chronic pain, and pediatric anesthesiology to name a few. It really comes down to your preference and interests and is more popular with physicians interested in academic medicine.

One of the advantages of the Anesthesiology Specialty is that it seems you need to know everything about everything. Everyone’s familiar with Surgeries and procedures, but there’s also children, pregnant women and more complex cases such as cardiac anesthesia, critical care and pain management (chronic and acute). 

Advice for first and second students: study hard but look for shadowing opportunities. It’s important, if not more, to figure out what you don’t enjoy early on. Personally, Dr. D shared that he is happiest when practicing medicine at bedside. Don’t pass on workshops that involve airway management, intubation, or ultrasound taught by upper classmates and residents. 

Advice for third and fourth year students: Remote interviews are a double-edged sword since the convenience is a cost-saving measure and opens the opportunity to more applicants. Fellowship programs may signal what one might expect as a resident. An absence of fellowship positions could mean more opportunities for residents to be more involved in a broader range cases. Also, it can be a pre-requisite for some academic medicine faculty positions if you’re interested in a building a career within the subspecialty. 

On what would have done differently: professional relationships are key. Consider your future interactions with surgeons, nurses, administrative staff etc. - they are on your team and you will need their help at one point or another.