why research and science

I’m in one of those classic first-day-of-rotation moments without too much to do… So since I’ve got some time, it seems like a good opportunity to touch briefly on a topic I’ve mentioned in a couple of recent posts: research and advanced science.
To answer the obvious question, do you need to do research, and do you need to take advanced science courses to get into medical school? The answer is no.
It’s that simple. There are lots of different kinds of people who get into medical school and if you have lots of clinical experience and you want to be a clinician, then that’s great.
But I do want to make an argument for research, and for more advanced science courses.
First, more advanced science courses. Lots of oldpremeds want to haul ass through the prereqs at absolute top speed, no frills, no additions. There are plenty of good reasons in our lives to take this approach. However, there are some good reasons not to. First, if you take this approach, you will risk making science into only a set of hoops to be jumped; or, at best, a set of interesting facts to be learned. It’s only in more advanced classes, or going to lab journal clubs, or going to science talks, that you really start to get a taste of science as a way of thinking and a way of looking at the world. It’s only there that you will really get a chance to read some of the primary literature–that is, science papers which report on the results and implications of a set of experiments performed by the authors.
I think that’s worth doing for a couple of reasons. First, it allows you get more deeply into a part of science you think is really interesting. That alone makes science something that’s yours instead of the product of the recommendations of the American Association of Medical Colleges. It allows you to go deeply into parts of science that you think are beautiful and satisfying.
And it trains you to read scientific literature in the future–which ideally you will do as a dedicated physician-in-training.
Perhaps most importantly it helps you understand how the scientific method works–how people go about formulating a hypothesis and testing it. As pathdr2b pointed out in my description of how I bumble my way through a differential diagnosis, that method is very much part of the underlying way that doctors think. In fact, one of the best lessons about diagnosis I’ve learned is something I learned from my old lab boss–that good scientists try to prove themselves wrong, not prove themselves right. If you try every possible way you can to try to prove yourself wrong and you can’t do it, then you can provisionally say that you’re right. (Until someone proves you wrong, of course.) I like this way of thinking about diagnosis and it’s not something I’ve learned from my clinical professors–who usually don’t talk about their underlying thought processes, but just illustrate what they do.
Working in a lab also helps you learn how to actually formulate and present a scientific argument–for instance, when you present your own results at a lab meeting, or at a scientific conference, or even better in a publication. As it turns out, this is quite useful for doctors too. It helps you recognize what arguments in the literature are well-crafted and well-supported, and which are not. (You won’t be satisfied with simple assertions of truth.) And it helps you put together scientific arguments in a structured way–which, as it turns out, is a lot like what you do when you do a formal presentation of a patient to your attending or to your colleagues. I was recently teaching presentation style to two second-year students and asked, “Have either of you guys worked in a lab?” Both said yes. That allowed me to really explain presentations as being like something they’d done before–and helped them understand the underlying structure of what I was teaching them how to do. A presentation is an argument for a point of view about a patient; but it puts together that argument by presenting all of the pertinent positives and negatives–which means, presenting the data that might support or not support alternative hypotheses, while in the end making a case for your hypothesis and conclusion. (This took me so long to realize that it’s not even funny. I was really lousy at presentations at first because I thought they were a chance for everyone to get together and talk about the patient. That is not the case. They are a chance for you to explain and justify your thinking about the patient.)
There are also some mercenary arguments for science exposure for premeds–that many academic physicians are also scientific researchers and therefore respect the people with lab experience when looking at med school applicants; or that there is funding for research exposure that there is not for community volunteering; and so on. People will make these arguments but I think they should all be rejected. Rather, you should do science because it’s beautiful, and because it will help you learn how to think in different ways.
Based on the idea of doing science because it’s beautiful, this brings me to the next portion of this post: how do you get the opportunity to do science? The specifics are detailed and lengthy, but the broad guideline is quite simple: follow what moves you. I loved the immune system, I loved T-cells, I loved big theories, and I ended up working in the lab of someone who created big theories of the immune system and set me on to doing an experiment with T-cells. I was so interested in what she did that I kept pestering her ("Well, I know you don’t have any lab bench space right now, but maybe I could just go get articles from the library for you and come to lab meetings?), and got myself a spot that way. I wouldn’t have been able to make that case if I didn’t think her work was beautiful and about beautiful things. (Namely, T-cells and the immune system.) Follow what moves you in science, as in most other things.

Thanks joe for the wonderful advice.
While I do think clinical exp is important, and some degree of patient care exposure is essential, lab research work is a different view of how medicine is approached and how it is to be built upon to better outcomes for future patients. This view is essential even for those who do not go into research themselves, but as a physician, you will need to read these journals just to keep abreast of new developments in patient care, and be able to weed out which articles are worthy and which are not, due to their method of data collection and analyzation.
I have found that attending lab journal clubs is a great deal of fun, and when doing so, you actually apply what you learned in basic science classes. And for taking advanced level classes, if you can, by all means do it. I have a set of unfortunate circumstances that prohibited me from doing so while in college, and I almost didn’t get this position because I did not. I did follow what “moved” me and have had a great deal of fun. (As a student I worked in another lab and did not have the same experience, perhaps because it wasn’t what I wanted to cure.) I love the immune system and pulmonology, and while doing library research, I saw that one of the authors that published a great deal on airway remodeling had a lab where I had gone to school and still lived. So I just contacted him about it, and volunteered for a while until he could know my style, and I got hired. Now I work on various projects studying asthma.
You never know what will happen, so if you read something and are interested in the project, send the author an email, arrange an appointment, but don’t be afraid. At the worst, they will say that they do not have time, and at best you get a great conversation, maybe some experience, and even a sort of ‘practice interview’ (at least it was for me! I am terribly shy)
I will say that the issue I have the most trouble with is the use of animals in labs, and it had prevented me from getting lab experience for almost a year post-graduation. I realized that if I didn’t want to be someone’s assistant forever, I had to deal with this issue, and this worked for me:
1. It is sad, all of the animals that die and suffer, but medicine would not further if we didn’t use them, and it would be much more unsafe for humans to not utilize this step.
2. Everyone that handles the animals likes them, and hates to kill them and do them harm. There are various regulatory committees that oversee animal usage, aimed at eliminating any suffering felt by the animal.
3. I actually discussed this issue with my PI, and he stated it so perfectly, that “At some point, you have to move beyond theory and into the realm of proof. You can not wholly predict what something will do in a biological system, and sometimes what looks good on paper turns out to be the opposite in a system, due to some unknown reaction or complication.” In his case, one of his articles was about having the opposite outcome due to a unexpected enzymatic action.
I don’t know if any of you have concerns about working with animals in the lab, but think of it also fron the animal’s view, they would not want anyone handling them that did not care, and most animals are bred for this reason, even genetically altered to be useful in research (which is why they should not be mixed in the WT!)