On Publications and Presentations

I'm pretty much neck-deep in research projects right now, so research is on my mind a lot. One thought that popped up, relevant to the previous post, is the nature of research productivity that is valued through a physician's career, especially in the early stages.

The culture in universities is to put a fairly high emphasis on publications. This follows directly from the incentives for professors and other career researchers, where "Publish or Perish" is very much a reality - maybe not so much on the "Perish" side, but the incentive to publish to secure grants and provide for career advancement absolutely exists. This mentality rubs off on pre-medical students, who often believe that research is worthwhile if and only if it leads to a publication.

Yet when it comes to medical school applications in Canada, having a publication is not that important. A few schools don't even look at publications. For those schools that do consider research output, while a publication may be a nice bonus to an application, it's the research experience itself. The premium of having a publication over a conference presentation appears to be rather minimal, even at research-focused schools such as U of T.

In medical school and residency, this attitude towards publications and presentations largely continues - while publications are preferred, presentations are often completely acceptable. There are some exceptions, of course, where residencies expect publications during med school to match to their programs and/or during their residency program itself, but these seem to be the minority. This state of affairs makes absolute sense to me, and helps mitigate challenge of encouraging research experience from future physicians when many have no interest in being career researchers.

The trouble with publications as a tool for evaluating a candidate in medicine is that they're really not suited to determine research aptitude at the early stages of a career. For the most part, pre-meds, med students and residents do not run their own research projects. Rather, they join an existing project or start one under the direction a supervisor. This puts much of the power to produce a publishable manuscript out of the hands of those trainees. The type of project, when the trainee joins the project, and the preferences of their supervisor typically dominate any efforts on the part of the trainee to push the project forward. This effectively means that whether a trainee gets a publication from a research project is largely up to chance. Even when a publication comes, how that reflects on the abilities of the trainee can be highly variable.

Presentations avoid a lot of those limitations. They are relatively easy to get, provided a student or resident has put some effort into a research project. They're not held to the same standards as publications, don't necessarily require a fully-completed study, and there are ample opportunities for presentation in virtually all fields. There is a bit of stratification of quality - some conferences are more prestigious/competitive than others, oral presentations are generally considered more meaningful than poster presentations - but that stratification is not nearly as significant or formalized as journal publications. Basically, a presentation is a presentation.

All else being equal, a publication is harder to obtain than a presentation, and for anyone considering a long-term career in research, it's worth pushing for the publication. For those just looking to advance along the pathway to being a physician, a publication often works just fine. In terms of balancing the need to evaluate trainees for their research chops without unduly punishing those who hate research or are simply unlucky, asking for presentations is a much more reasonable standard than insisting on full publications.