3rd Year Ophthalmology Switch

[Buca]

I just started 3rd year and recently had my first exposure to Ophthalmology and really enjoyed it. However, as it is an extremely competitive speciality I am worried it is too late to be competitive without having to take a research year (which I am not willing to do). I was currently interested in another competitive speciality before being exposed to Optho and will have around 6 publications from that speciality. If I start doing Optho research immediately and can hopefully publish 1-2 papers before CARMs, along with doing all of my pre-carms electives in Optho, would this be competitive enough, especially for an Ontario school? What else can I do to improve my competitiveness? Finally, how difficult is it to back-up with family medicine if I have no pre-carms electives in it? 

[Bambi]

Your plan is good, although you should do 1 elective in FM. I applied to FM and 2 competitive specialties. For one, I was a gunner and did the entire 9 yards, including publication and presentation. For the competitive surgical specialty, I had just 1 week of an elective under my belt when the CaRMS Application deadline appeared.  I got my 3 in terviews and was accepted to the competitive surgical specialty where I was virtually an accidental applicant competing against all the competitive gunners. Anything is possible!

[goleafsgochris]

There is a chance but you would have to hit opthal HARD with research.  Try to get a few pubs.  You will likely want to show that you have totally abandoned the other specialty you were trying to get into, so do close to 100% of your electives from here on in in opthal.  And still if I'm being honest--chances are still high youll need a research year, so plan for that.

[Bambi]

I would imagine you still would want to consider applying to the original competitive specialty that originally interested you just to be sure you do match in the end - provided you would be happy there.

I applied to 2 competitive specialties and FM. I did not match in the competitive specialty for which I was a gunner, had a pub, etc.; and I matched for the competitive surgical specialty where on paper seemingly I did not have a prayer.

[Dermviser]

Are research years in opthal common these days in Canada? When do people complete them? During medical school or only after they go unmatched?

[distressedpremed]

Usually after they go unmatched, they use the year to build up their CV's/Resume's/clinical experience and re-apply. 

[ArchEnemy]

On 2017-10-31 at 10:09 PM, Buca said:

I just started 3rd year and recently had my first exposure to Ophthalmology and really enjoyed it. However, as it is an extremely competitive speciality I am worried it is too late to be competitive without having to take a research year (which I am not willing to do). I was currently interested in another competitive speciality before being exposed to Optho and will have around 6 publications from that speciality. If I start doing Optho research immediately and can hopefully publish 1-2 papers before CARMs, along with doing all of my pre-carms electives in Optho, would this be competitive enough, especially for an Ontario school? What else can I do to improve my competitiveness? Finally, how difficult is it to back-up with family medicine if I have no pre-carms electives in it? 

I do not think that taking a research year off DURING medical school is a good idea. It might be a red flag.

If you're taking a research year AFTER going unmatched, that's a different story.

[rmorelan]

1 hour ago, ArchEnemy said:

I do not think that taking a research year off DURING medical school is a good idea. It might be a red flag.

If you're taking a research year AFTER going unmatched, that's a different story.

if you are going to take a year off in medical school to do research then I would think ideally want to formally make that count - my school would let people into Masters or phD programs mid stride if they were good students and had a solid plan. That would help you no matter what the outcome likely. 

[Dermviser]

2 hours ago, ArchEnemy said:

I do not think that taking a research year off DURING medical school is a good idea. It might be a red flag.

If you're taking a research year AFTER going unmatched, that's a different story.

How it can be a red flag? I'm confused. You have an interest in research, so you decided to take a year to do research during medical school.

[ArchEnemy]

7 hours ago, Dermviser said:

How it can be a red flag? I'm confused. You have an interest in research, so you decided to take a year to do research during medical school.

There are many reasons why medical students take a year off, but the most common two I have personally witnessed are: 1) Medical Illness, and 2) Poor academic performance. During that one year, many of them continue to engage in research that they had already been working on previously and will list it as such on their CV.

Again, this is just from my personal experiences. Perhaps "red flag" wasn't the proper term, but rather a "flag". 

[a7x]

Deleted

[rmorelan]

8 hours ago, Dermviser said:

How it can be a red flag? I'm confused. You have an interest in research, so you decided to take a year to do research during medical school.

simply because it is unusual and anything unusual prompts investigation - particularly in any competitive residency program where the number of applicants is relatively small so people can investigate to a greater degree. If for no other reasons than you committed to a 4 year process (usually) and then changed your mind to do something else with certain administration complications as a result. Will you try and do something similar in the residency program? 

More reason to where ever possible to something like that officially in some way. Basically you never really know how some programs will take unusual situations, ha. 

That doesn't mean don't do it.

[goleafsgochris]

11 hours ago, rmorelan said:

simply because it is unusual and anything unusual prompts investigation - particularly in any competitive residency program where the number of applicants is relatively small so people can investigate to a greater degree. If for no other reasons than you committed to a 4 year process (usually) and then changed your mind to do something else with certain administration complications as a result. Will you try and do something similar in the residency program? 

More reason to where ever possible to something like that officially in some way. Basically you never really know how some programs will take unusual situations, ha. 

That doesn't mean don't do it.

This.

The problem with competitive residency programs is its a bit like applying for med school.  They get so many apps (and a lot of them look similar), that they may be more willing to throw apps out if there is something even slightly perceivable as negative.  I never saw someone take a research year mid med school, although I did see several people take one b/w med school and residency

 

[JohnGrisham]

3 hours ago, goleafsgochris said:

This.

The problem with competitive residency programs is its a bit like applying for med school.  They get so many apps (and a lot of them look similar), that they may be more willing to throw apps out if there is something even slightly perceivable as negative.  I never saw someone take a research year mid med school, although I did see several people take one b/w med school and residency

 

Unless the school offers MD/Masters combos, where you take the masters during medical school and essentially have a 5 year MD. I dont think programs would see anything wrong with that - but this is pure speculating anyways.

[Oussedik]

Medical students in the US commonly take "research years" between their third and fourth year. Most commonly, such students are eyeing competitive residencies such as dermatology or ophthalmology. 

I published a manuscript exploring this concept in JAMA Dermatology a couple months ago - if you're interested: https://jamanetwork.com/journals/jamadermatology/article-abstract/2635347

COI: I'm from Canada and I took a research year in the US between my third and fourth year.

[ArchEnemy]

To add onto the points covered by rmorelan and goleafsgochris, it is a known fact that plenty of medical students engage in research and are able to publish during medical school without having to take a research year. This is especially true In the smaller, hyper-competitive specialties like Dermatology & Plastic Surgery, where every applicant seems to have a few first-author publications.

In OP's case, he has proven his research productivity with 6 publications during medical school and would not fall in the example above.

To OP, Ophthalmology is not as competitive as it used to be anymore. With 6 publications, I would say you are strong from the research perspective. As long as you commit most of your electives to Ophthalmology and not split them between the two specialties, you should not encounter too much difficulties declaring your passion/commitment to Ophthalmology.

[rmorelan]

4 hours ago, Oussedik said:

Medical students in the US commonly take "research years" between their third and fourth year. Most commonly, such students are eyeing competitive residencies such as dermatology or ophthalmology. 

I published a manuscript exploring this concept in JAMA Dermatology a couple months ago - if you're interested: https://jamanetwork.com/journals/jamadermatology/article-abstract/2635347

COI: I'm from Canada and I took a research year in the US between my third and fourth year.

that is quite interesting - how did you come to set that up, and did your find your program supportive (sometimes there have been issues with space allocation at the schools I have been at with people taking years off etc). Why did you decide to do that rather than a Msc etc (access to a superior lab perhaps?)

[rmorelan]

1 hour ago, ArchEnemy said:

To add onto the points covered by rmorelan and goleafsgochris, it is a known fact that plenty of medical students engage in research and are able to publish during medical school without having to take a research year. This is especially true In the smaller, hyper-competitive specialties like Dermatology & Plastic Surgery, where every applicant seems to have a few first-author publications.

In OP's case, he has proven his research productivity with 6 publications during medical school and would not fall in the example above.

To OP, Ophthalmology is not as competitive as it used to be anymore. With 6 publications, I would say you are strong from the research perspective. As long as you commit most of your electives to Ophthalmology and not split them between the two specialties, you should not encounter too much difficulties declaring your passion/commitment to Ophthalmology.

http://www.lasikmd.com/

when you see things like that you wonder what is going on in the ophthalmology world 

(side note - wow, their overhead costs are through the roof)

[psychiatry2017]

3 hours ago, rmorelan said:

http://www.lasikmd.com/

when you see things like that you wonder what is going on in the ophthalmology world 

(side note - wow, their overhead costs are through the roof)

 I am not sure that their overhead costs are through the roof for LASIK MD, it is rather a private business model.

I think that Lasik surgery is a small part of ophthalmology practice, they usually don't hire new fresh grads, rather more experienced LASIK surgeons who do this part-time, even the LASIK MD founders have affiliations with academic hospitals.

I think that all surgical specialties (besides plastic surgery), the lack of OR time and budget cuts force a lot of surgeons to do locum & part-time & endless fellowships that lead to nowhere...

[Oussedik]

3 hours ago, rmorelan said:

that is quite interesting - how did you come to set that up, and did your find your program supportive (sometimes there have been issues with space allocation at the schools I have been at with people taking years off etc). Why did you decide to do that rather than a Msc etc (access to a superior lab perhaps?)

In the US, 50% of students interested in Dermatology take research years.

Unfortunately, my program was not too supportive. They discouraged I take the year. I had to be quite pushy.

On the contrary, the lab I was part of was brilliant. It's one of the top dermatology programs in the US. My supervisor has 850+ publications. It was a super productive year, I published nearly 20 manuscripts, wrote many grants, and wrote IRB protocols while recruiting patients for a multitude of studies. Msc is good, but this "research fellowship" experience gave me a chance to see how academic dermatology is. If I am fortunate enough to match into dermatology, which I really hope I do, I'll be able to continue with my research. Five years is a lot, and now that I have a strong research background, I can hopefully publish a lot during my residency years.

[Dermviser]

Neat! Best of luck, Oussedik!!

[ZBL]

On 11/12/2017 at 9:02 PM, Oussedik said:

In the US, 50% of students interested in Dermatology take research years.

Unfortunately, my program was not too supportive. They discouraged I take the year. I had to be quite pushy.

On the contrary, the lab I was part of was brilliant. It's one of the top dermatology programs in the US. My supervisor has 850+ publications. It was a super productive year, I published nearly 20 manuscripts, wrote many grants, and wrote IRB protocols while recruiting patients for a multitude of studies. Msc is good, but this "research fellowship" experience gave me a chance to see how academic dermatology is. If I am fortunate enough to match into dermatology, which I really hope I do, I'll be able to continue with my research. Five years is a lot, and now that I have a strong research background, I can hopefully publish a lot during my residency years.

K I need to chime in on this. You published a lot, which is one thing (productive, as you say), but the quality of what you are publishing needs to be questioned when someone without much previous research experience shows up and scores 20 papers in one year. I looked up your pubmed. I'm not doubting your work ethic on any of this, as obviously that much writing takes a lot of time and indeed what you have done is productive, but don't fool yourself - a bunch of case reports and review articles DOES NOT equate to a strong research background. You essentially paid your way to a paper factory, which let you write review articles all day and tossed in one or two small pilot studies. That's called regurgitation of science. A MSc, or PhD while maybe not as "productive" teaches students the scientific method, how to design experiments, how to test hypotheses, how to interpret data, how to contribute something novel. A research fellowship, as you've described it, is just a matter of productivity, not scientific research training.  

Derm is one of those fields where "academia" is an afterthought. But show that to an academic cardiologist, neurologist or oncologist and they'll show you what's up. I'm sure the 20 papers will help you land a derm spot (I actually have no idea how PDs view productivity vs quality for derm), but just be aware of the fact that this is not what academic medicine really is or should be. 

[goleafsgochris]

11 hours ago, ZBL said:

K I need to chime in on this. You published a lot, which is one thing (productive, as you say), but the quality of what you are publishing needs to be questioned when someone without much previous research experience shows up and scores 20 papers in one year. I looked up your pubmed. I'm not doubting your work ethic on any of this, as obviously that much writing takes a lot of time and indeed what you have done is productive, but don't fool yourself - a bunch of case reports and review articles DOES NOT equate to a strong research background. You essentially paid your way to a paper factory, which let you write review articles all day and tossed in one or two small pilot studies. That's called regurgitation of science. A MSc, or PhD while maybe not as "productive" teaches students the scientific method, how to design experiments, how to test hypotheses, how to interpret data, how to contribute something novel. A research fellowship, as you've described it, is just a matter of productivity, not scientific research training.  

Derm is one of those fields where "academia" is an afterthought. But show that to an academic cardiologist, neurologist or oncologist and they'll show you what's up. I'm sure the 20 papers will help you land a derm spot (I actually have no idea how PDs view productivity vs quality for derm), but just be aware of the fact that this is not what academic medicine really is or should be. 

This has been discussed elsewhere, but for carms, research quantity (esiecially in the field of interest) generally trumps quality.  The people evaluating your app are typically not hardcore academics in a research sense (more clinician oriented), and aren't likely to be able to recognize nuances of "good" vs ok research.  Now ofc publishing in major journals would likely seem MORE impressive, but for getting into a residency program, details of research quality mean a lot less than "doing some relevant research."

[ZBL]

1 hour ago, goleafsgochris said:

This has been discussed elsewhere, but for carms, research quantity (esiecially in the field of interest) generally trumps quality.  The people evaluating your app are typically not hardcore academics in a research sense (more clinician oriented), and aren't likely to be able to recognize nuances of "good" vs ok research.  Now ofc publishing in major journals would likely seem MORE impressive, but for getting into a residency program, details of research quality mean a lot less than "doing some relevant research."

Not arguing this - I did say it would probably help him match. 

 

I’m just commenting that in terms of developing “a strong research background” as this person claims they have achieved from paying their way through a paper mill for a year, I can guarantee they have not and I don’t care how many publications came from it. No grant agency is paying for case reports, review articles or inconsequential pilot studies and no one is learning real science by doing any of those things. So I’m not sure what their area of research strength is - case reports? Searching medline/pubmed?

 

Whether PDs in derm or any other specialty recognizes that I don’t know and don’t really care - just pointing out the facts above to highlight that those one year “research fellowships” are a bit silly. Students would be infinitely better off doing a grad degree, at their Canadian school with a derm (or other specialty like ophthal) program and work with those preceptors directly. They’d get letters from preceptors in Canada, potentially at their home program, who know each other much more than they know the Americans, you get two years to learn real science and also publish case reports or reviews if you wish, and you can receive travel funds to go to a US lab for a month or two if you wish. Plus you can get paid to do it through grad student scholarships. And you get a tangible degree out of it. Derm/ophthal is not the same in Canada as it is in the US where step score and research output trumps all else. In Canada there’s a much greater role for letters from faculty and getting along with the team.

 

That said, if you look at the CaRMS pages for derm, pretty much all of them say that students with proven experience in basic or clinical research are especially encouraged to apply. I’m guessing this means more than just case reports/review articles, and if you google residents at various programs many have an MSc or PhD. 

[Oussedik]

On 11/18/2017 at 6:58 PM, ZBL said:

K I need to chime in on this. You published a lot, which is one thing (productive, as you say), but the quality of what you are publishing needs to be questioned when someone without much previous research experience shows up and scores 20 papers in one year.

How do you know I don't have much previous research experience? I've held many different research positions, from basic science, to translational, to clinical. Unfortunately, not all my experiences were as fruitful, publications-wise  .

On 11/18/2017 at 6:58 PM, ZBL said:

I'm not doubting your work ethic on any of this, as obviously that much writing takes a lot of time and indeed what you have done is productive, but don't fool yourself - a bunch of case reports and review articles DOES NOT equate to a strong research background.

Not all my papers were case reports and review articles  . On the contrary, I have many on-going original research projects - these take a long time to put together. I personally think if someone is self-motivated, he or she can publish many review articles and/or case reports. You just need to sit down and write. Review articles and case reports have an important place in academia.

On 11/18/2017 at 6:58 PM, ZBL said:

 A MSc, or PhD while maybe not as "productive" teaches students the scientific method, how to design experiments, how to test hypotheses, how to interpret data, how to contribute something novel.

I'll politely disagree. During my research fellowship I had the pleasant good fortune to interact with social psychologists, epidemiologists, statisticians, researchers from other field, etc. I also had the chance to attend many different research seminars. Furthermore, we are very fortunate in 2018 to have access to unlimited information. I love epidemiology and statistics - I asked our research staff if they recommend me any good statistical books to read. I read and I learned. If I had any questions I would ask the staff. If an individual is intrinsically motivated, they can learn a lot, and quite fast!

On 11/18/2017 at 6:58 PM, ZBL said:

Derm is one of those fields where "academia" is an afterthought. 

Academia is an afterthought? What do you mean! Dermatology is a rapidly evolving field. We have the great pleasure of sharing management with many other providers such as hematologists, allergists, rheumatologists, pathologists, radio-oncologists, etc... Furthermore, the advent of biologics has been one of the major advancements in medicine and has substantially improved patient outcomes. Add teledermatology and targeted melanoma treatment to the list, major advancements in dermatology are already present and on-going. Don't forget the recent advancements in cosmetic dermatology, which is only a small percentage of what a dermatologist does.

----

Let me add, @ZBL, that I understand your concerns, but for a different reason. I think these one-year research fellowships, even though I completed one, can be detrimental for other reasons. If you are interested, I published in JAMA why people completing one-year research fellowships shouldn't necessarily be looked upon more favorably than those that didn't:

https://jamanetwork.com/journals/jamadermatology/article-abstract/2635347?redirect=true