Sunday, February 15, 2009

Question re: opportunities if I don't finish my residency

I got another question today from a resident (a physician in training, not someone living in a skilled nursing facility). The question had to do with career opportunities for people who don't complete a medical or surgical residency. Since I get asked this quite often, I write about my response.

Here was my reply:

I hope I can provide some help since I know quite a few people who've been in similar situations. Let me start by saying that the types of non-clinical opportunities can vary depending on where you live. How open are you to relocating?

The next issue is more of a practical one: do you have student loans? If not, then you have tremendous flexibility to explore and find the "perfect" job for you. However, if you're burdened by student loans, then you have to make some career decisions based on the practical reality of loan repayment (unless you have other sources of income such as family, spouse, etc.)

You're absolutely right in saying that you would have many more opportunities if you complete your residency and become board certified in a medical or surgical speciality. However, life in residency can be very miserable and it can also change people in different ways so you have to know yourself and the type of things you're able and willing to personally handle. People with unhealthy coping skills may find themselves addicted to drugs and alcohol and heading down a very dangerous one-way path. I'm not suggesting that's going to happen to you, but I always like to emphasize the importance of coping with the strenuous work hours, the tremendous pressures, and the emotional burdens that are commonly encountered in the clinical setting.

Also remember that residency dramatically changes after your internship year. Instead of being the scut monkey who has to run around everywhere, you have more responsibility in teaching and guiding your team. With that added responsibility comes different pressures. Will that be a relief or an added burden for you compared to internship? Many people report that their 2nd year of residency was so much better compared to the first. Also, are you in the "right program?" I'm sure you're aware of how certain programs have a reputation for being very malignant while others are very "cush." Have you beein in touch with your friends and colleagues from medical school? What is life like for them?

Medical communications is very broad. I write about some of the basics here in my blog:
http://mdjosephkim.blogspot.com/2009/02/world-of-medical-education.html

I've also written about CME here:
http://mdjosephkim.blogspot.com/search/label/cme

I've also written a little bit about opportunities for people with no residency experience:
http://mdjosephkim.blogspot.com/search/label/residency

I'd be happy to share more with you as you develop more specific questions about the world of medical communications.

As for working the working environment - this can be a tricky one. You have to assess the culture of each company. The corporate world can be harsh and people may easily work more than 80 hrs/week (you thought residency had long hours!). However, there are companies that are very family-friendly where people stay for many years (hence, they have a very low turnover rate). The most flexible path is to be a freelance medical writer or consultant. You don't need any residency experience to be an excellent medical writer. Some of the best writers are scientists, pharmacists, and nurses. You need strong writing skills and you have to be very motivated.

My final word of advice - discuss this matter with your program director sooner than later. He/she may provide you with some great advice and guidance. However, keep in mind that this individual may not be very knowledgeable about non-clinical opportunities.

Perhaps we can discuss this some more after you've had a chance to think about all these issues. I wish you the best and hope that you'll stay in touch.

1 comment:

  1. ALL BUT DISSERTATION (ABD)


    Are you at the ABD destination in your program?

    There are two types of Ph.D. candidates that fall into this category:

    1) The "just arrived" and anxious to move forward.

    2) The "been there for awhile" and think they will never move forward.


    While both types may need help to move on, it is the latter that is likely to derive the most benefit from this article and become motivated to complete, perhaps, the most important event in their life.


    You are intelligent enough to have come this far, there is no reason (from an academic stand point) to linger in the "ABD Zone." The longer you are there, the more difficult it becomes to pick up the pieces and move forward.


    A qualified and experienced consultant who works with Ph.D candidates understands the special circumstances that can lead to ABD status (e.g. hectic fulltime job, family, and other personal issues). The question is, how do you find a qualified consultant?


    The best way to get started is with a phone call to a consultant and ask the question: "How can you help me move beyond the ABD level and complete my Ph.D. program"?


    For many doctoral students, the most rigorous parts of a quantitative or mixed-methods dissertation are:


    1) Methods Section

    Study Design
    Research questions and hypothesis formulation
    Development of instrumentation
    Describing the independent and dependent variables
    Writing the data analysis plan
    Performing a Power Analysis to justify the sample size and writing about it



    2) Results Section

    Performing the Data Analysis
    Understanding the analysis results
    Reporting the results.
    Many Ph.D. candidates seem to hit a brick wall and feel disarmed when called upon to work on the "methods" and "results" section of their dissertation. This is the point where many students diligently search for help calling on their mentor, peers, university assistance and even Google. This is also the time when the student may ask themselves the question "HOW MUCH HELP IS TOO MUCH"?

    Surely no one will deny that having your dissertation written for you is very wrong. On the other hand, it is not unusual for doctoral students to get help on specific aspects of their dissertation (e.g. APA formatting and editing). It is also not unusual for advisors to encourage students to seek outside help with the statistical aspects of their dissertation.

    As a distance learning student it is almost essential you seek outside assistance for the methods and results section of your dissertation. The very nature of distance learning suggests the need for not only outside help but help from someone gifted in explaining highly technical concepts in understandable language by telephone and e-mail.

    The ideal time to begin working with a statistical consultant is once you have a topic and you have done some preliminary literature review. Otherwise, you run the risk of unnecessarily complicating your study. This could result in the consultant being unable to help you, unless you are willing to start over with the problem statement, purpose of the study, research questions, instrumentation and data analysis plan.

    As stated above, many students hit their dissertation "brick wall" when they encounter the statistical considerations. Frequently, a student will struggle for months before they seek a consultant to help them. This often leads to additional tuition costs and missed graduation dates. (The number of Ph.D candidates not completing their program is staggering)



    If I were to name a single reason why a Ph.D candidate, doing a quantitative or mixed-methods study gets off track in their program, it is the statistics and their fear of statistics. So, the question is whether or not it is ethical to get help at all. If so, how much help is too much?

    I don't know if there has ever been a survey of dissertation committee members who were asked this question, however, I know many advisors take the following position when they suggest or approve outside help:

    To a large extent the process is self controlling. If the student relies too much on a consultant, the product may look good, however, the student will be unable to defend his/her dissertation.

    It takes a committed effort on the part of the student and the consultant (resulting in a collaborative/teaching exchange) to have the student responsible for the data and thoroughly understand the statistics. This is not accomplished in just one or two emails or a single telephone conversation. It is a dynamic process; one that calls for unending patience on the consultants part and perseverance on the students part.

    The day the student walks in front of the committee to defend, there should be no question as to his/her understanding of statistics. It is the consultant’s job to see to it this occurs.

    When their defense is successful, the question "was the help too much" is answered.

    If you are a Ph.D candidate and would like additional information, you may wish to review the referenced sites below:

    Boyd

    Reference sites:

    http://www.statisticallysignificantconsulting.com:80/Statistically-Significant-Ethics.htm

    http://www.usdla.org/

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