Clinical Research: Why It Matters in 2018
At the 2017 Canadian Society of Internal Medicine conference,
had the privilege of receiving the Dr. David Sackett Senior Investigator
Award. I wish to share some key points from a lecture about clinical
research and why it (still) matters in 2018 I gave at that time. It is
directed at aspiring clinical investigators and early-career physicians
who may be considering a full or partial career in clinical research but
may be uncertain about whether it is “worth it”. As you read this, I will
strive to convince you that clinical research does matter and whether
you decide to just dip your toe into the shallows or to dive right into
the deep end, it will enrich your life and make you a better doctor.
First, let us consider reasons not to make research part of your work
activities. I have heard aspiring researchers and even seasoned colleagues
offer the following deterrents: “There are too many administrative
barriersor “I am not good at writing, especially grants. My favourite
is: “All the important questions have already been answered. Although
agree that in 2018 clinical research has a denser administrative
component (e.g., fifteen-page vs. one-page consent forms) and there
are more hoops to jump through (e.g., contracts and legal review)
than previously, other research opportunities have emerged. Despite
the increased administration associated with clinical research, these
changes are positive as they provide patients and researchers more
checks and balances to allow the highest possible standards to conduct
research. As for the claim about a shrinking research landscape, one
can rebut it by saying that addressing one research question will create
new questions. Moreover, in 2018, new fields of research have emerged
that may not have been as noticeable in the past. These include research
on quality improvement initiatives (e.g., effectiveness of Choosing
Wisely), big-data research (e.g., using linked administrative databases
assess intervention and drug-related harm), and research related to
knowledge translation (e.g., is the evidence getting through). Addressing
whether and how we are delivering health care and determining if it is
done in an efficient manner is of paramount importance in 2018.
Moreover, these new areas (combined with the more traditional clinical
research domains) will gain increasing traction among funding agencies
when tensions increase relating to an ageing population of health care
consumers and the limited resources to address these increasing needs.
For aspiring young clinicians who are including research as part of
their career plans may I suggest a few dos and donts.
1. Do think of your own ideas for projects: You are more likely to
be committed if you have ownership of the project. Don’t
quickly accept that your ideas lack merit: Be respectful but
wary of naysayers.
2. Do trust your supervisor’s opinions: Their experience
will guide you in the right path. Don’t always trust your
supervisor’s opinions: Their experience may be biased
towards their own priorities.
3. Do think big: Be ambitious in your goals; ideas do not cost
anything and curiosity is of paramount importance. Don’t
think too big: Temper ambition with practicality and park
more ambitious projects for later.
4. Do try to be in a good research environment: The
environment will enable exposure to different opportunities.
Don’t be discouraged if you in a small centre: Ideas and one or
two committed advocates matter.
5. Do maintain your integrity: Once lost, integrity is difficult
to regain and not worth the risk of losing. Dont burn
bridges: The research world is small and there is no value in
antagonizing colleagues or institutions.
Let us now consider why research should be built into your career
as an internist. For academic internists, it provides a vehicle towards
cultivating expertise and being on the cutting edge of new developments
in a chosen field which, in turn, will provide a substrate for academic
career advancement. For community internists, a research focus can
provide a foundation for leadership and administrative advancement.
Apart from the getting ahead” aspect, a career that includes research
provides other benefits such as the ongoing reward and gratification of
intellectual stimulation and the interaction with colleagues at a state-
of-the-art level. However, the most important benefit is the effect it has
on the care of your patients: by engaging in research, we are constantly
asking questions of what we do, how we do it, and why we do it. This
critical self-evaluation of how we practice medicine itself a by-product
of a research environment enables us to better communicate with
and care for our patients.
Jim Douketis, MD
Canadian Journal of General Internal Medicine
4 Volume 13, Issue 2, 2018