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Toward Understanding Discovery in Medicine
 Photo courtesy of Terry Maratos-Flier Terry Maratos-Flier |
Terry Maratos-Flier, an associate professor of medicine at Beth Israel Deaconess Medical Center, runs a lab studying obesity and the regulation of energy balance. She is also an associate master in the Peabody Society. Last spring, she vetted almost two dozen student proposals for research funding. “They ranged from A-plus to C,” she recalled. The deficiencies included murky hypotheses and muddled outlines about how students intended to test their theories.
In an era of potentially breathtaking medical breakthroughs—and when clinicians who also do research are in short supply—HMS debuts a mandatory course for first-year students, The Role of Discovery in Medicine, in the 2007 January block. Up to 40 faculty members will lecture or lead the course’s seminars, including Maratos-Flier and her course co-developer, Ellen Seely, associate professor of medicine at Brigham and Women’s Hospital.
“You would never have someone graduate from medical school without having seen a patient,” Seely said. “We want to be sure that people don’t graduate without being exposed to what happens in research.”
The Role of Discovery in Medicine will include topics from research ethics to what an institutional review board does to how to write a research proposal. The overriding goal, said Maratos-Flier, is to introduce students to the step-by-step of medical investigation: “What kinds of tools do you need if you want to pose a hypothesis to answer a question? How do you formulate a question? When you’re a practicing physician, how do you absorb the changes in the medical landscape that are constantly happening?”
Seely, who investigates blood pressure regulation in pregnant and postmenopausal women, argues that even doctors who never set foot in the lab or participate in research scholarship need exposure to the methods used. “When you look for information on how to treat your patients, what you’re looking at are recommendations based on research, which is called evidence-based medicine. If you understand how the studies were performed, you can better individualize the therapy.”
Photo Courtesy of Brigham and Women’s Hospital Ellen Seely |
A percentage of HMS students never gets into a research lab during medical education—some chased away by the misconception that lab work means injecting rats and other tasks that might not be appealing, said Maratos-Flier. In reality, research also entails everything from a population study to public-policy investigations, among the many other non–lab-based areas of scholarly research in which faculty members are engaged. She and Seely also plan to include a lecture on research ethics. “There’s a universe of research fraud, from making up data to picking the results you like and ignoring the results you don’t like. Students understand that it’s absolutely wrong to make up data, but what about dropping experiments that are inconsistent? What are conflicts of interest?”
Seminars will zero in on how researchers in two particular areas—breast cancer and obesity–diabetes—framed their question, researched it at the basic-science and clinical-research levels, and developed experiments to test their findings. Importantly, students will learn how these findings altered doctors’ perceptions of patients and what the societal impact of this research was. In addition to giving lectures themselves, Seely and Maratos-Flier will audit seminars to see what works and what does not.
This new course will be integrated with the other January-block course, Clinical Epidemiology and Population Health, which shares several of its themes. In addition, the two courses will culminate in a joint final project, the development of a written research proposal, which the students may or may not choose to pursue. “The process of writing a proposal is important, whether they do the project or not,” Seely said.
The Role of Discovery in Medicine is intended to introduce students to the importance of scholarship in medicine and to stimulate students to participate with a faculty mentor in a scholarly project. Initially, an in-depth scholarly project will be an optional component of the new integrated curriculum that was inaugurated this academic year; ultimately, however, after the program is piloted for several years, an in-depth scholarly project will be required of all students.