Jesse M. Pines, MD MBA
Vice President, Young Physician Section, AAEM

Embarking on a career in academic emergency medicine can be very rewarding. Few careers outside the practice of academic medicine allow people to combine such diverse activities as teaching, research and clinical care. Emergency physicians trained as clinicians go into academic medicine for many reasons; some love to do research, some love teaching residents and working in a collaborative environment, but most enjoy both.

The transition from residency to academic practice can be difficult for clinically trained emergency physicians because many academic institutions require research and publication as criteria for academic promotion. However, the expectation that a clinician will be able to perform well-designed research without close mentoring and formal training is unrealistic given the methodological requirements for publishing in emergency medicine journals. Instead, graduating emergency physicians entering academic practice must specialize either clinically, in research or both in order to ensure a successful career in academic practice.

Based on my experiences as a recent emergency medicine residency graduate, I have created the following “Tips for Success.” I hope this article serves as a guide for gaining success early and ensuring a rewarding career for young emergency physicians.

1. Find a Niche: The general recommendation for emergency physicians entering academics is to do a fellowship, and I agree. Fellowships allow protected time to focus on developing skills and expertise in one specific area. Some residents are able to do this during their residency but most cannot. Also, given the increasing competitiveness for academic jobs in emergency medicine, a fellowship can give you a real “leg up” in landing that first job in the city where you want to live. Not having a specific niche or area of interest is, and has been, a common pitfall in academic emergency medicine. Because we work in such diverse areas, it is easy to get interested in being a generalist emergency medicine researcher. That is, today I’ll do a cardiac project, tomorrow one on dental pain and next week, one on . I would not recommend pursuing a diversified research strategy. I did this during residency but have since focused on a few specific areas. What happens is that you end up scratching the surface in many different areas, and it becomes very difficult to make a significant contribution in any specific area. You also need to do a new literature search every time you do another project, which can be very time consuming. You should choose up to two specific areas of focus where you want to make a contribution, understand the literature and then gain the skills needed. You can have a research niche, a clinical niche (such as hyperbaric medicine, education, toxicology or pediatrics) or both, but you should find a niche and find it early. That means you might have to say no to certain projects. If you’re doing research into acute coronary syndrome and a friend asks you to do a book chapter on snake envenomations, think hard before you agree. Some projects will take a lot more time than you expect. As you gain skills and expertise, more opportunities will become available to you; try and avoid as many distractions as possible that are not central to your niche.
    
2. Find a mentor: Find a mentor who has both the time and interest to invest in you and your success. This is why fellowships can be so beneficial; it gives a reason for senior faculty (the mentor) to be interested in you (the fellow). The ideal mentor or fellowship director is a successful senior faculty member in your department (or in an outside department) with whom you can spend dedicated one-on-one time working to develop your ideas and maximize your success. This can be a challenge, however, because often senior faculty can be very busy. Also, if you are in a clinical fellowship and your mentor is not a strong researcher, find formally-trained and/or well-published researchers in your department who you can meet with to discuss your research projects in advance.
    
3. Be a mentor: As you develop skills, it is important to give back and mentor others. This is the cycle of academic medicine. Make time to help others, whether they are other junior faculty, residents, medical students or others. Being a mentor is very rewarding, and from this experience, you may be able to reap dividends for a lifetime as your mentees gain prominence.
    
4. Collaborate: Since it may be difficult to frequently meet with a senior faculty mentor, find other people who are interested in your specific area and collaborate with them. Working in teams can be a frustrating process, but often team members have skills or perspectives that can improve the overall quality of your work. Early on, you should strive to put together a team who can work toward a specific goal; whether it is developing a clinical protocol or applying for a grant, there are huge benefits to collaboration.
    
5. Seek Input before You Proceed: Here’s a tip in doing high-quality research: think about your projects carefully, write them down (including background, aims, hypotheses and skeleton tables - - this can serve as the template for your paper) and then present your ideas to others in your department or those with formal research experience. I cannot stress enough the value of presenting your ideas. Getting input at the beginning can make your project better, refine your questions and increase the likelihood of final publication. First, think about the big picture regarding your project, “What is the question? Why is this important?” Charging forward with data collection first, then thinking about what it means later (yes, I have done this), is not a good way to do research. Good preparation and planning at the beginning of a project can really increase the chance that a project will succeed. Think about the result you want and what it means. I always like to think about the last line of the abstract and what it will say if my hypothesis is correct. If you don’t think this is important or meaningful, you may want to rethink your project.
    
6. Set Specific Goals: Ask your mentor to sit down with you and map out specific goals regarding further training (i.e., research or clinical training) and put together a timeline. Short-term goals may include applying for a specific grant, writing a paper or performing a research project; long-term goals may include setting up a research program or a new clinical protocol in your area.
    
7. Always Write It Down: When you’re committing to a specific set of goals or a project, write them down in your calendar so you can refer back to them. This will ensure that you’re on track and moving forward appropriately. If you’re developing a new idea, committing it to paper (or computer bytes) is absolutely essential. This will be the working document that you use either to get funding or departmental support for a new initiative. Also, by writing it down, you become more committed to the project.
    
8. Keep At It and Don’t Give Up: Academic medicine is difficult, and there are often setbacks regarding specific projects and plans. Success takes perseverance and hard work. Don’t get discouraged. Papers will get rejected, grants won’t get funded, and you may suffer personal and professional setbacks. To be a real success in academic emergency medicine, you need to keep at it and stay focused on achieving your goals.