S5E5: The Pressures to be Published

Margaux: Okay. Sorry. I have to clear my throat. Maybe I'll sit on the floor. I don't know. Okay. It's hard to get comfortable these days.

All right. Hey, everyone. Welcome to "Bundle of Hers." This is our first episode with our new voices and Harjit and myself all together after their Identity Series. So if you haven't checked that out, you should definitely go listen to all three of them from Ha, Lina, and Mariam.

Today, though, we have an episode coming for you with Harjit, Ha, and Lina, and myself, Margaux, in the studio. So I'm really excited to record with you all for the first time.

Harjit: Me too. I'm so excited. How do you guys feel recording with us, Lina?

Lina: There's a better maybe sense of comfort right now just because we're with the pros. But I'm still kind of nervous and we'll get better with time, I guess.

Margaux: You guys are already sounding amazing compared to how we sounded in our first season. It's like you . . . I don't know. You just have the natural radio voice or something.

Harjit: We stumbled gracefully, and now we are authentically growing into our voices, and you have already reached that point.

Margaux: Yeah. So it can only be amazing from here. Today, I wanted to talk about research and the pressure to do research, but also this like need to be in the spotlight, something that we kind of have been talking a lot about together.

But I just wanted to preface that we did do a "Decolonizing Medical Research" episode back in Season 3. And so this episode will be different, but if you want a foundation on what it means to decolonize research and the places where research is important in medicine and our discussions around that, go back to that episode. This one is going to be a little bit more focused on the need to publish everything and anything and this pressure to sort of do it for your career gains.

Hạ: For clout.

Margaux: For clout, yeah. A hundred percent.

And the way I started thinking about this episode is I think across the board in residencies and sometimes in medical school, you do journal clubs, which is where you get together with a group of people and talk about published articles and sort of digest them for yourselves.

And last year in pediatrics, they didn't have any real criteria for what you could talk about in journal club. And so I got to present on decolonizing research methods, which also sort of built off that other episode that I talked about, and that's research founded by Linda Smith.

Then this year, in psychiatry, we are also doing journal club. However, there are such strict regulations on what you can present on that when I wanted to talk about something, I couldn't find any articles that fit the criteria. I felt very stifled in that.

And then last week or something, there's been a lot of rhetoric around, "This person is such a great researcher and such a rising star in their own research, and they're going to go far in their career," and this sort of talk about how you have to have research to be getting ahead. And I know that existed in medical school too for residency.

So I just wanted to open the discussion with that, about if you guys have any experiences about being pressured to talk about research in a way that didn't fit your needs or necessarily views of how research should be.

Hạ: I think to start off for a bit of context is that I, like Harjit, did a degree in biomedical engineering. And so I've done a lot of research on more that side of things. And switching over to medical school, it was kind of a weird sense of seeing how people approached research compared to what I had been used to when I was in biomedical engineering and doing research with the biomedical engineering lab.

The big focus that I really noticed was it was really focused more on numbers of publications and just getting your name out. So it was like, "Let's jump into this paper that's already started quite a bit, and that you might not really even know about, but we can give you authorship if you just do a little bit of work here and there for it."

It made me really sad because one of the things that I really liked about research was really that investigative process and really getting to delve deep into things and really understand things a lot.

A lot of the work that I did with biomedical engineering research really was sitting down and thinking, "Hey, what is the need that we have in this patient population and how can we, using the skill sets that we have, design experiments and create hypotheses to then drive what we do?"

But something that I really notice with medical school research now is that because there's such an emphasis on publications, there really isn't that investigative process driving the research. It's more like, "Oh, look, we have this data from this event. Let's just compile that data and publish it." I 100% admit that I'm victim of being a part of it because of this emphasis that we need to do publications.

Harjit: Yeah, Ha. I'm actually so excited you said that because this is exactly what I was thinking. I, like you said, also did a degree in biomedical engineering. I remember we spent a whole year understanding what research was, how to present it, how to talk about it.

I think even though it may not appear that way, there's a lot of love that's put into research, right? It's really about pushing the boundaries of knowledge. And you can only push boundaries of knowledge if you understand the origins of knowledge, right? Knowledge is a process that you have to really understand what exists, what the intention is of the research.

So even in medical school, when I think about how research is talked about or journal clubs as a medical student and now a resident, it's utilized in two ways, right? One way is it's a utilization of, "Hey, listen to me. I read this, so I know what I'm saying." And then the other thing it's used for is putting up this prestige around a person, like, "I am an academic," or, "I'm in academia," whatever that means.

I think it's really sad, but when we go back to research, are we even honoring what research is? And do we even think of research in that way? I feel like if we have time and we have to put an effort into something, we should be passionate about it. Research isn't an easy process. It's something that you really need to feel for and move forward.

I love how you talk about this, because I remember thinking even when I was in medical school, "Wow, there's such a talk about research." I think I never really cared about it, but granted I did do a lot of research as an undergrad, so I didn't feel like I needed it either.

So I understand why I didn't have the pressure, but I do understand why a lot of medical students feel the pressure that they need to do research. It's like, "Oh, this counts for residencies," or, "You need to do this, this, and this." And that's a lot of pressure, but now being a resident, I'm like, "That pressure is unnecessary because, again, we're not vowing what research is."

Lina: I think you bring up a good point, Harjit, because I'm one of those students. I did not do really any research in my undergrad. I had a few projects here and there. Some of them were to kind of fit the research criteria that I needed, and I didn't really understand research or understand much of it. But coming into medical school, it just felt like another situation where we needed to check off the boxes for residency.

And there was a huge pressure into trying to get as many publications as you can without really thinking about out the research or the process or why we're doing this or the need behind it. It was very frustrating to see that because there were a lot of times I was, "Why are we even doing this?" Basically, just to check off a box.

It's a lot of pressure and it kind of takes away from the true meaning of research and it takes away from the passion of it, and it just suddenly becomes something we have to do. I've seen that happen to a lot of people.

Margaux: To the point that maybe all three of you made, the impact and the intent of the research is lost in this model of quantity over quality and passion of research that we are expected to do at all stages along this career path.

For example, in journal club the other day, it came up that we were talking about a medication trial of some antipsychotic, and they brought up that a weakness of the study was that most of the population was white men. Then that's kind of where the conversation stopped.

It's like, "Oh, yeah, that's a weakness. Moving on." And it's like, "Wait, wait, wait. Let's talk about this. Why do we just accept this as a weakness, but you still take this as fact that this medication is working instead of actually having a conversation about the flaws of the research system and the process that allows this to be the standard and the norm?"

And even if you try to bring it up, most people don't want to engage in that conversation. Maybe they don't have the tools or they just don't feel comfortable exploring beyond what research could look like if it was inclusive or if it was challenged.

We're all talking about, "This is research as we know it, and how we're supposed to do it, and as a checkbox." Sort of being robots. And now all of a sudden, someone is trying to challenge that and it's easier to just ignore it. That's what is so frustrating in these journal clubs.

Hạ: I think it's so hilarious that it just gets ignored because the research that I know that I fell in love with, it's about, "Oh, these are the limitations. So in our future studies, let's address those limitations. Let's push so that our research can be more applicable."

And that's one of the things that I feel so sad about. I loved research. I did two gap years doing research, and it was such my jam. And then going into med school, I felt like I just got that love taken away from me because people just didn't appreciate the process in the way that it should be appreciated.

Margaux: Exactly, Ha. And when we're talking about passion for the research and the work and understanding the impact and the intent that we're doing, I think that has also fully been drained in the way that people are now trying to publish their passion projects.

So it's like you will start a club at school, and then all of a sudden somebody is like, "Hey, we should publish this," as if that's the only reason you are doing the work, is to get the credit for it. And that also just drives me crazy.

Harjit, did you have a comment?

Harjit: I'm just thinking about all the times we started something and someone is like, "Oh, we should publish the data." And I'm like, "When did we even think that we're going to do research? What are we being intentional about? Why are we publishing this data? We don't even know what we're doing with this data." So it just reminds me of all those times. I think Lina had a comment as well.

Lina: Yes. I think when you talked about impact, right now it's a lot about quantity. And when we do want to think about something that will impact or something that will lead to help or change or addressing actual limitations or weaknesses, suddenly it's too much, or it's too big of a problem to look into, or it's too long of research. "You're just a med student. You're not a Ph.D. student."

These are just projects that I've thought about before and I've been told, "Focus on things that will take the least amount of time because you don't have time for the actual things that will make an impact." And that's really frustrating, because I do see where good research can make a great impact, but that's not what we're told to focus on. Or we're just being told to kind of think about easier stuff to do.

Margaux: Or is even accepted, right? Like a journal would even accept that.

Lina: Exactly.

Margaux: And the passion projects turned into research or data. Just because you have data, A, doesn't mean you should publish it. But, B, I think it's rooted in this patriarchal or capitalistic idea that parallels white feminism that we talked about last season, where there's the perception that there's only a limited amount of space for people at the top, right?

There's this pressure that if you feel like you're doing something good, like the club that you started is doing well, then you have to publish that data to not only, A, prove that it's doing well, but, B, get credit for it before anyone else does so you can be at that limited space at the top.

That's also what drives me crazy. It's like you should be doing the club or the passion project because you're passionate about it, not because you need to prove to other people that it works or something.

Hạ: Yeah. Jumping off of what you just said, Margaux, I get very frustrated when a lot of those passion projects are related to diversity, equity, inclusion, anti-racism. I'm criticizing a lot, but I am part of the system and I have taken part in a lot of research regarding these initiatives.

Part of it is just because I really enjoy doing them just to do them. I recognize that the only way I'm going to get people to listen to me or to get people in interested in the research is if I go, "Well, we're going to collect data to publish and to make this institution look really amazing and that we're being progressive."

But it's frustrating for me because . . . I do want to give the nuance to say that I do think that equity and anti-racist papers should be published, but they should be published by people of color whose voices are always silenced so that they can bring their perspective into the medical education realm.

But with that nuance, to understand what then frustrates me about it is I feel that people are just publishing just to kind of go, "Look at me. We're doing the work. We really care about this." But they don't really think about the impact and they also don't really realize that anti-racism is built off of community. It's not built off of capitalistic metrics of number of publications and things like that.

So by publishing that research, it's actually not really as anti-racist or as radical as the institutions think they are.

Lina: I think it's a very hard balance between trying to fight the system or fight what research is right now and being a part of it, because it seems to me that the only way the system will listen if we do present the data or if we present the numbers of what is happening or how this impacts us. It is a balance to be like, "I don't want to participate in the system, but I do need to participate," to bring out the things that you mentioned, Ha.

Margaux: To parallel what both of you said, Lina and Ha, Leen shared with us an article the other day from the "Annals of Emergency Medicine Journal." And it was an open letter that they signed, "Your tired emergency medicine colleagues of color."

The article was calling out basically what you were explaining, Ha. If you're doing real anti-racist work, it's not visible and the impact is not being felt at this time.

I think those are the kinds of publications that we need to have more of. But in this system of quantity over quality and data and metrics is the top and the truth, I wonder how well this sits with the people who actually need to see it and read it as data or research.

And that comes back to the problem of if we only have this one standard and westernized view of what acceptable research is, acceptable data is, then can we actually make progress forward?

And having conversations about decolonizing research, accepting different forms of research, and allowing different communities, different people to present their own data, why does it have to be just Ph.D. or MDs publishing in these journals? I'm sure there are plenty of people in the general public who have just as much knowledge about some of these topics that we could be learning from but are excluded from this system.

And so I think the conversation about decolonizing research needs to be continued, but like you said, we all have to buy into this. It's such a balance. And we can talk about that right now. How do we navigate knowing what we want to do and how we want the system to change, but also knowing that we need to play the game to get to where we want to be to have more leverage and power to make change? It's such a complicated thing, Harjit.

Harjit: Yeah, it definitely is complex. I've actually been thinking about this too a lot, because I actually had a colleague of mine who I'm working with on some work that is specific to BIPOC communities.

Without giving too much away, they basically were like, "We need to publish this before other people will, because other people will." And in a sense, that almost made me really sad because I was like, "Oh my god, now it's a race of who can publish this work first."

This other person and me both identify as BIPOC, and the other people in this group don't identify as BIPOC. And they were very specific, "It's a sad reality, but this is what we should do."

So that's just something that I also wanted to mention, is sometimes you do have to be a part of the system, be and do things in a way that you get the credit you deserve.

But even the thought about credit, again, can we just go back to our conversation about white feminism, as we mentioned it? We're trying to get it in a system that wasn't built for us. It's a white supremacist system built for certain groups, certain genders, and sexualities to be in power, and then we have to also climb the same ladder.

So, honestly, when I used to rebel against research . . . I know everyone thinks I'm like always like, "You don't need to do research. You don't need to do research." It's because I get so angry because I'm like, "This is my rebellion. I am not going to do what people tell me to do. I'm going to do what I want to do." But now I will say every time I think of a project, I'm thinking, "Who is on this project?" Because if everyone else can do it, why can't we?

Hạ: I feel like a lot of time, it just seeps out the joy of everything that I love and everything that is central to my identity. For instance, as I've mentioned already, I really did love research. For a while, I wanted to do an MD-Ph.D. because I really like the thought and the care placed into research. And I feel like research, when done well, is something built out of community, out of collaboration, out of love. It isn't about one-upping someone else.

And I think that research is just one nuance of many other things with the way that our medical system strips away that love and that collaboration that really does make people happier and really does bring more joy.

It's something that is very frustrating for me and it's something that I'm still trying to navigate, is how I can hold onto that joy even as I have to play the game that the system tells me to play.

Harjit: That's actually so beautiful that you said that, because I was just thinking . . . You're right. Let's just imagine I see a kid get a really deep cut and I have a suture kit. I can suture their cut, right? And I can do it by myself. But research is one thing you can't do by yourself. You need a group and you need someone with you. You're right. It makes it seem very much like, "This is what I want to do so I can prove that I deserve to be here," when you're already in medical school.

Lina: There's a lot of emphasis that we see in front of us, how to get your name up there or to get the credit, you want to be first author or co-author. Your name needs to be up there. And when we look at the quantity, it turns it into a very individualistic metric and you're kind of being part of a capitalistic system and a system that's wanting you to be on top of others.

Ha and Harjit, you bring up a good point. We need to bring back the research we love that actually comes out of a community perspective and uplifting each other's voices and getting the credit together, because we're trying to create an impact for the community or change something within the community itself rather than the original or the goal that's pushed upon us of, "Oh, you have to be on top of everyone else with the amount of publications or what you're getting out there."

Margaux: That so nicely wraps up the summary of the episode, too, Lina. I think that is really the root of our dissonance with research and the conversations that we've had outside of this podcast around research and the need of peers to be in the spotlight and get credit for everything and for us trying to keep, or find, or regain this passion that we either came into medical school with or just trying to keep that fire going.

And I think that while we do have to play the game, like we talked about, to get advanced in the career and the way the system is set up, there are ways to sneak in and change the system subtly along the way.

I think you all brought up great points of ways to do that, but I just encourage everyone that if you ever have to present at journal club, try pushing the boundaries and bringing up a paper that maybe doesn't 100% fit, or at the end sneak in something about whatever you want to talk about or just a few slides here and there. There are ways to rebel.

Hạ: And I think another thing to also think about that has been touched on by everybody here today is to think about bringing up stuff that community has done and initiatives that bring change that don't fit the evidence-based research elitist guidelines. Really uplift local voices and the voice that haven't been heard before. I think that's also so critical.

Harjit: Again, I think research is a beautiful process by its origins. We just have to go back to decolonizing it, as we had mentioned in our previous episodes, and also understand there are a lot of other ways you can show people your authenticity and passions. Sometimes research isn't it for some people, and that's okay. We don't all have to be the same.

Again, we are not sheep. We are lions. We do not follow people. We are leaders. If authentically research isn't your thing, that's okay.

I do want to say that, and I think it's very necessary, because I think a lot of medical students, a lot of residents, a lot of people in medicine feel like they have to do research to be a doctor. Yes, it can be important, and if you want to do it, you should do it. But if you don't do it, it doesn't mean you won't be a resident. I know people will give you that view, but remember that your authenticity is what's going to lead you to residency.

And that's for everybody who's listening, and even us, because I think we forget that sometimes. I struggled myself always feeling like I had to do research because of what people were telling me. Research is important if you want to do it. We can reimagine worlds in a different way if we want to.

We need to take back our power. And in a sense, research is power, which is so sad. It's another way people get ahead in the system, right? So we need to take back our power and reimagine the way that we can utilize it.

Lina: One hundred percent.

Margaux: Do you want to close it Harjit? I think you said everything that needed to be said.

Harjit: Okay. So let me just remember how to do this and then I will close it. Yes, I remember.

Thank you so much for joining us for a "Bundle of Hers" episode. So with that, thank you for joining us and listening to "Bundle of Hers."

If you want to listen to our podcast, you can visit bundleofhers.com. We are on all platforms. We also have an Instagram @bundleofhers. Please follow. If you have any comments, send us messages. We always love them. We always love your feedback, and we think your voice is important as well.

Should we see if Lina and Ha have ways to say bye? Bushra used to say it all the time for us.

Margaux: Like our signature "bye-bye"?

Hạ: Bye-bye. I don't know. I can't do it.

Lina: Bye.

Harjit: Oh, that's a good one, Lina.

Hạ: Give it to Lina. Lina, cover it.

Lina: Or as Chloe would want. Chloe, how do we end this?

Margaux: Cute.