“A garbage man, that’s what I am!” said one of the other member of the Research Director’s Interest Group of ACEP in disgust.
“How so?” I asked.
“Resident research is, for the most part, garbage. It’s my job to rescue it and try to make it publishable,” he replied.
Well, now, I thought. I don’t think of it as garbage. It is just… early? Uninformed? A good beginning? And a good way to train young doctors to start thinking about how we go about adding new knowledge. And also, train them to think about different ways to get there from here.
I mused about how I had gotten into research. Why had I chosen that path? Well, I love to teach. I always knew I wanted to be an academician. I wanted to design educational programs. But all the teaching programs wanted someone who was residency trained in emergency medicine for the program director position at that time, and I did my residency in family medicine. Why would I have trained in emergency medicine, after all? When I graduated medical school, there were no accredited emergency residencies. I grandfathered. I passed the boards. I had been residency-trained, just not in the right specialty. But I was shut out. So, what to do? Next up was designing research projects. Teaching residents how to think in terms of evidence. Building research curricula. Design, teaching, learning new stuff? What’s not to love?
Like most women, I felt I had to prepare myself before I sought such a position instead of assuming myself qualified and then learning the ropes. So I enrolled in an On-Job, On-Campus two year Master’s Program in Research Design and Statistical Analysis at the University of Michigan. It was superb. It was expensive. And the internet was young, making it was really hard to run my stats homework via a dial-up connection.
And then the world fell apart. My mentor and chair left, moved to another state, got lung cancer and died. The administration chose our least respected faculty member to be the new chair and they chose to remove all protégées of the preceding chair. Our program director was fired under embarrassing circumstances. I tried to stick it out, to pass through the eye of the needle. Finally, I could not tolerate the harassment — changing my shifts from previously negotiated day shifts to a night shifts with no more than 24 hours warning. That was the final straw. Then, they tried to back-date my termination data so as not to pay me any vacation time or for my last shift. Even their lawyers wouldn’t back them on that. But I was out of there.
It took years to get back into real academia. I finished the Masters, but couldn’t get a copy of SPSS or SAS and the right databases to play with. So I lost those skills. Eventually, though, a place that wanted a research director but didn’t have a residency yet “took a chance” on me. I got no resources, so I made my own. A decade passed. I helped lots of residents get their scholarly work done. I even published a little under my own name! Eventually I seemed to have gotten some kind of reputation – for the positive! – in my field.
I took another place at a fledgling residency – or several of them. The hospital is an amazing place – a community hospital which had never previously been academic, started five residencies within three years! I got to build all the infrastructure: an IRB, an Office of Grants and Research, the research curriculum, the Unified Graduation Requirement for all the residencies, and work with all the attendings to help them get published. Fun! Garbage collecting? I don’t think so!
Now I am looking at the next phase of my life. Retirement!! Before I leave academic medicine, I want to train a replacement. (And if I don’t have to train, why that’s a bonus!) But given a year or two, I can train. I can leave my infrastructure, my books, my functional IRB with an experienced administrator and several published attendings. Wanna come look at “garbage” with me?
Dr. Totten is a CEP Physician Partner
Great article Vicken! Appreciate all you have done at Kaweah Delta. Proud to have you as a partner and colleague!