Resident Voice: “Failure is the mother of success” and other advice on resident research

Earlier this year, I found this sage advice at the end of my meal: “Failure is the mother of success.” I don’t often subscribe to the fortune cookie school of thought, but the words resonated with me. Failure is an expected complication of a successful career; and in research, it’s basically required.

Research is now standard for radiation oncology residents, with most producing at least one first-author publication.¹ More than 90% of chief residents have done retrospective research, half have pursued basic science or translational projects, and 1 in 5 have conducted resident-led prospective clinical trials.² Small and large failures lead to all this success. Research often doesn’t work; experiments fail, IRBs reject ideas, or trials don’t accrue. Research is always two steps forward, one step back.

So, with failure in mind, here is my advice on resident research:

1. Find a Good Mentor, Find Several. Mentors should be available and generous. They should be able to meet on a semi-regular basis and allow you to take ownership of projects. As more than half of rad onc applicants already have publications,³ many residents are walking in the door with mentors. A good mentor is your mentor for life; a bad mentor (even one with a famous name) may not be worth maintaining. Working with a variety of mentors broadens your skillset, and lifts pressure if a specific relationship or project goes sideways.

2. Ask Questions That Matter (to You and to Patients). I always think: How can this information eventually improve cancer care for my patients? Meaningful research generates passion and enthusiasm; this is the fire that drives you to continue when you cannot look at one more spreadsheet, gel, or DVH. If your research doesn’t “spark joy,” it’s time to thank your mentor for their time and find a new project.

3. Ask Questions That Can Be Answered. I keep a list of interesting clinical questions waiting for answers. Some require large datasets, others need new data acquisition. Knowing which questions can be answered how and which resources are available to you is vital.

4. Make Sure Your Work is New. The first thing I start when thinking of a research idea is the “References” section. I collect the prior work on the topic to assess the novelty of the idea and the previous methods used to explore it. This saves work in the end and allows you to shape the project to truly fill the unmet need.

5. Aim High (and Expect to Miss). I often joke about how many times I have “donated” $60 to the Journal of Clinical Oncology. Desk rejects sting. My first 5 grant applications failed. I started my dedicated research time with the lofty goal of 10 accepted first-author publications in 12 months; I fully expected to fail but told all my research mentors my plans in order to set the bar high. It was amazing how much support I got for my ridiculous goal. Five original research articles, 2 case reports, 1 review article, a commentary, and a book chapter later I realized I never would have been this productive if I hadn’t had this insane expectation. Of note: Missing the mark (“What only 7 manuscripts?”) would also have clearly been acceptable.

I started residency knowing I wanted to do clinical research. For the past 5 years, I’ve worked hard to carve a niche for myself studying financial toxicity and how out-of-pocket costs can have real world effects on quality of life and quality of care.⁴ I set high goals and failed more times than I can count. And I’ve often wondered if we wouldn’t all do better—have less burnout, be happier residents, have more genuine success—if we embraced failure.

Failure is an option. Just fail forward. 

References

1. Verma V, Burt L, Gimotty PA, et al. Contemporary trends in radiation oncology resident research. Int J Radiat Oncol Biol Phys. 2016;96:915-918.
2. Nabavizadeh N, Burt LM, Mancini BR, et al. Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States. Int J Radiat Oncol Biol Phys. 2016;94:228-234.
3. McClelland S 3rd, Thomas CR Jr, Wilson LD, et al. Association of preresidency peer-reviewed publications with radiation oncology resident choice of academic versus private practice career. Pract Radiat Oncol. 2017;7:364-367.
4. 4.Chino F. My unfortunate introduction into the financial toxicity of cancer care in America-march forth. JAMA Oncol. 2018;4:628-629.