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Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.
Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.
Are you attracted to research but not sure if it’s your sole calling as a prospective hospitalist? Whether you think you might want to steer quality improvement (QI) studies in the community setting or veer toward an academic/research career, hospital medicine offers an array of paths to career satisfaction.
“There is so much room in hospital medicine to find your research niche,” says Luci K. Leykum, MD, MBA, MSc, SFHM, hospital medicine division chief and associate dean for clinical affairs at University of Texas Health Science Center in San Antonio. As chair of SHM’s Research Committee, Dr. Leykum can attest to the range of hospitalists’ research pursuits: from basic science (what biomarkers best predict poor outcomes in patients with acute lung injury?) to care organization (are hospitalist schedules and workload associated with patient outcomes?) to implementation (how do we most effectively implement best practices for care transitions?) studies.1-6
In addition to Dr. Leykum, The Hospitalist consulted Vineet Arora, MD, MPP, FACP, SFHM, associate professor of medicine at the University of Chicago and chair of SHM’s Physicians in Training Committee, and Margaret Fang, MD, MPH, FHM, associate professor and clinician-investigator in the department of medicine at University of California San Francisco (UCSF) Medical Center and a member of the SHM Research Committee. Critical to research success, they agree, is acquiring skills in research methodology and project design, finding the right mentor(s) to help guide your career, and committing to and preserving time to focus on your research.
“After residency,” Dr. Arora notes, “you have accumulated the clinical skills to become a hospitalist, but you usually have not accumulated the skill it takes to be a researcher, which is why you need to do additional training.”
Is a Fellowship Necessary?
The paths to incorporating research into one’s HM career can be diverse. Although a fellowship is often the recommended route, there are other ways to acquire research methodology and experience with project design. Dr. Leykum began her career as a clinician-educator at Columbia University in New York. Although she found the QI work enjoyable, she realized she wanted to understand how to create more meaningful and sustainable changes in inpatient care delivery. She later acquired a master’s degree in clinical investigation. She has published more than 25 journal articles, several in collaboration with other SHM colleagues.
As a result, perhaps, of her own experience—and the fact that HM is still a young subspecialty with limited HM-specific fellowship opportunities—Dr. Leykum says that she would consider hiring a junior faculty member who had not yet completed a fellowship. “I think you have to consider people who might be talented candidates that you are willing to groom,” she says. However, she says she would structure the position so that the faculty member could immediately pursue additional research training.
–Dr. Fang
Dr. Fang completed a two-year, general medical research fellowship right after her residency and obtained her master of public health degree at that time. “I do agree,” she says, “that the fastest way to doing research well is to get some additional training.”
Even if you are not aiming to become a full-time investigator, Dr. Arora says a research fellowship “gives you very marketable skills. You will still gain skills that will be helpful to your career—and not all research is done by clinician investigators in academic settings.”
Another advantage of a fellowship, Dr. Arora says, is that it allows you to explore whether you are truly suited for a research career. All three hospitalists agreed that researchers share many of the same abilities: to focus, accept uncertainty, persevere, work in teams, and handle rejection.
The Right Mentorship
Dr. Fang says working with an experienced mentor is a vital ingredient to launching a research career. One key factor in selecting a fellowship program, according to Dr. Leykum, is the institution’s or group’s track record in developing junior faculty. To gain an understanding of how the partnership would work on a practical level, the candidate should ask specific questions of prospective mentors, such as:
- How well do research interests and methodological expertise match?
- How often would we meet?
- Who would be involved in the mentorship team?
- What would each person contribute?
In hospital medicine, it could be challenging to find a mentor within one’s own division. Dr. Fang points out that there are a variety of other ways to obtain career, academic, and research mentorship: For example, SHM’s Research Committee has a fledgling mentoring program, and the Society of General Internal Medicine offers both one-on-one and longitudinal year-long mentoring. “You can also look to other specialty divisions that are complementary,” she suggests. If you’re interested in antimicrobial stewardship, for example, your institution’s division of infectious disease might be a logical choice for your mentorship and collaboration search.
Balance Clinical, Research Time
Although securing protected research time concerns trainees as well as academic faculty (see “Protect, Make the Most of Your Time,”), deleting clinical time from the equation is not the answer.
“I find, from being a researcher,” says Dr. Arora, “that sometimes you need a break from research. And clinical work can provide that break. Whatever you do, you need a balance.”
Dr. Leykum says she learned, about five years ago, that 10 weeks of clinical rotation was too little. By choice, she elects to put in more clinical time. Why? “Being in that [clinical] environment helps you hone your questions, especially if they concern how to better deliver care,” she says. “In addition, you interact with specialists and learn about the new research that they are implementing.”
The cross-feed between clinical and research pursuits can be particularly rich, Dr. Fang says. In addition to her other posts at UCSF, she is medical director of the anticoagulation clinic.
“I find a lot of my research ideas flow very naturally out of the situations I see as a hospitalist,” she says. “You often see something that you want to improve and design a project to try and achieve those aims.”
Gretchen Henkel is a freelance writer in southern California.
Protect, Make the Most of Your Time
Transitioning from a research fellowship to your first job, you will be negotiating for protected research time. A typical junior faculty position might involve 70% research time and 30% clinical time, says Dr. Arora, who cautions candidates to clarify how the 30% clinical time will be structured. “In a hospitalist group, 30% clinical time can look quite different and have varying amounts of nights and undesirable shifts.” It is appropriate, she noted, to ask this question, because this may have implications for your research time.
Candidates also need clarity from prospective institutions about funding expectations. Be prepared to secure your own funding as soon as possible. “You need to always look ahead,” says Dr. Arora, who suggests that young investigators view their first job as a “mini-grant” and use their time during that period to develop other funding sources, such as the NIH K, or career development, awards. —GH
References
- Leykum LK, Parekh VI, Sharpe B, Boonyasai RT, Centor RM. Tried and true: a survey of successfully promoted academic hospitalists. J Hosp Med. 2011;6(7):411-415.
- McKenna K, Leykum LK, McDaniel RR. The role of improvising in patient care. Health Care Manage Rev. 2013;38(1):1-8.
- Arora VM, Fish M, Basu A, et al. Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. J Am Geriatr Soc. 2010;58(9):1642-1648.
- Arora VM, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300(10):1146-1153.
- Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4): 395-401.
- Mission JF, Kerlan RK, Tan JH, Fang MC. Rates and predictors of plans for inferior vena cava filter retrieval in hospitalized patients. J Gen Intern Med. 2010;25(4):321-325.