Choosing a clinical science and teaching career in academic medicine

Clinical trials are carried out using specific protocols that adhere to accepted standards, with IRB requirements being an important component.

Teaching a fellow is much different than teaching a second year resident, and teaching expectations are defined by the institution and are specialty dependent.

Faculty appointments and promotion expectations vary significantly between institutions, with some requiring progression from assistant to associate professor within seven years or requiring the faculty member to move on.

Mentorship has a two-phase approach: identifying a mentor to help you mature, and learning how to become a mentor yourself so you can mentor others.

When designing a clinical research question, pick an easy question that you can answer early in your career, such as whether an open pyloromyotomy is better than a laparoscopic pyloromyotomy.

Statistical analysis can be complex; for example, calculating pain scores requires different statistical approaches than length of stay because two is not exactly twice one on a pain scale.

There is a home for every manuscript someplace; if a manuscript does not get accepted to one journal, submit it to the next journal rather than giving up.

Junior faculty members need time for maturity and should not expect to teach fellows or residents like someone who has been out for 20 years; it is acceptable to step back and perform operations yourself when not comfortable with teaching situations.

There is a direct relationship between operating room management and outcomes; developing a calm demeanor and team-oriented environment where nurses feel comfortable raising concerns is important.

If you do not have any patients in M&M, you are not really doing cases that are pushing the envelope and trying to make people better; the goal is to limit failures and limit how bad the failures are.

Focusing on critical care during training allows surgeons to have complete interactions with separate subsets of people, such as neonatologists, and discuss processes intelligently, which is important for studying processes involving two different disciplines.

The vast majority of what we do in surgery is anecdotal, done because we were taught that way by our leaders, though there is an immense push towards evidence-based medicine.

In clinical research, the entire system has to be in place for a randomized controlled trial, meaning lab techs, nurses, anesthesiologists, patients, families, and radiology all need to know about the trial, or it will not work well or will take a long time.

When starting early in a clinical research career, try to limit interactions with other departments because you will not have the background to be successful with complex interdepartmental collaborations.

The IRB is trying to protect researchers and the institution, not obstruct research; developing a strong relationship with the IRB and avoiding a 'cops and robbers' mentality is important.

The biggest error in over 1500 patients in randomized controlled trials is consent errors, including consenting people with old consents, improper dating, or having someone without custody sign consent for children.

Epic EMR is a data mine with valuable tools for clinical research, compared to Cerner which has fewer data mining capabilities.

For the irrigation versus no irrigation trial for perforated appendicitis, patients were enrolled in both the single incision laparoscopic appendectomy versus three port trial and the irrigation trial because perforation status was unknown until the operation started.

When managing multiple randomized controlled trials (15 randomized and 15 retrospective trials), a study coordinator is needed to handle IRB administrative tasks because the primary investigator cannot do that and still be a clinician.

If you are going to be in a bigger faculty group, make sure what you are going into is sustainable; avoid being the youngest person in a group where everyone else is over 57 years old because in five to six years all those people will be gone and you will be tasked with taking care of and building a practice while still in the infancy of your career.

Perforated appendicitis should be defined as either seeing a hole in the appendix or stool in the abdomen; if neither is present, it is acute appendicitis and abscess rates are no different than for simple appendicitis.

If you have a fever over 38.5 degrees on day two after perforated appendicitis, you have an 80% chance of developing an abscess.

It is an error in judgment to design a trial that will take five years to answer a question about rapidly changing technology (like surgical patches) because the question will not be clinically relevant in five years.

Necrotizing enterocolitis treatment currently occurs when the house is burning down; the goal should be finding how to stop the fire before it happens.

Over the speaker's career, 15-16 prospective trials were completed providing evidence-based approaches to numerous conditions including perforated appendicitis, reflux disease in children, burn care, empyema treatment, and single incision laparoscopic surgery for cholecystectomy and acute appendicitis.

The total time from starting to think about a trial until it is in print is approximately 5.5 years, including 6 months for trial design, 6-12 months for funding if necessary, 33 months for enrollment, 6 months from submission to presentation, and 6-12 months from presentation to publication.

In clinical science careers, you can operate as much as you want, unlike basic science careers where 75% lab time affects operative volumes; you may need 25% protected time early in your career.

Once you get through the first six months of trial design, the trial starts to run itself, and prospective data is way easier to work with than retrospective data because retrospective chart data is often missing or unreliable.

Of all the trials discussed, only one trial had funding; funding is not required to do a trial, especially if you are doing care that is already rendered.

If people in your institution or department are doing two different things for the same condition and you are not trying to answer which one is better, you may be ethically committing a violation by not doing a trial together.

Over an 80% enrollment rate was achieved over 10 years in Kansas City for randomized controlled trials when patients and parents were asked honestly with data explaining why the trial was being done.