“Publish or Perish” Part 1: The Pressure to Publish in an Academic Training Program

For many physicians in training, the pressure to be involved academically and publish research consistently is dramatic and overwhelming. So it makes sense that taking part in clinical research that results in publication is a requisite part of most applications to fellowship programs or jobs—especially in the more competitive specialties like general and interventional cardiology.

We all know colleagues who are the best technicians and/or clinicians we could ever meet but who cannot write a unique paragraph to save their lives. On the other hand, we know others who can crank out a Journal of the American College of Cardiology manuscript over a weekend when given the raw data yet still have difficulty performing a simple diagnostic heart cath.

The problem is that most people do not know which end of the spectrum they fall under until they near the end of their training. This is why involving yourself with research early on is important and should not abruptly stop after matching to a residency, fellowship, or advanced fellowship. Starting early will help you develop critical-thinking skills and understand the processes and elements of various research tools (eg, prospective data, retrospective series, and meta-analyses). Furthermore, the basic tenets of the research process stay with you whether you eventually end up in private practice or find an academic position.

Some of our colleagues have had the foresight to enroll in research-specific training programs in which the clinical volume is condensed into 2 years, followed by 2 years of dedicated research time. Other new physicians may reserve 1 or 2 years to complete a master of public health degree after subspecialty training; however, a quick survey of my peers revealed that those who pursue this route are in the minority.

Most training programs are based primarily on a clinical curriculum, with short infrequent research blocks interspersed throughout training. As such, it is important for all of us to understand:

• Academic-literature review and critical thinking will be a part of your life forever.
• To develop the skills needed to critically assess research, you have to partake in academic research yourself.
• Even if you have no interest in pursuing a career in academic cardiology, the Accreditation Council for Graduate Medical Education (ACGME) requires you to actively participate in research and to publish during training.
• If you are going to participate in clinical research during training, it takes more than a 9 to 5, Monday to Friday commitment. Research, case reports, and database management also must occur after the family goes to bed, in between cath cases, before clinic starts, or maybe even on the weekends.

So then how specifically are you supposed to get involved in research? There is no right or wrong way, and there most certainly is no magical recipe or algorithm. Ask your program director, senior fellows, or other mentors for advice. I have gained much insight from those who have come before me.

In my next post, I will list the specific strategies that have worked well at my institution—where most of our fellows leave with at least 2 or 3 publications, even if private practice is their ultimate goal. Read Part 2 here.