According to Liaison Committee on Medical Education (LCME) policy, medical education curricula should provide opportunities for and encourage medical student participation in research and scholarly activities. Some med students take the summer between first and second year while others may take elective time or a year-off to pursue more in-depth research experiences.
Med students may also choose to become the subject of research by participating in a clinical trials as patients, although I’m not sure this counts for credit. I’ve had a few experiences with supervised research. One summer, I reviewed and collected data from pediatric charts for a study about the development of prepubescent girls growing up in an urban city environment. I spent my afternoons in the department of medical records collecting data, reviewed the relevant literature and by summer’s end, I had increased the data set available, gained some skill with reading patient charts and presented my take on the research to faculty and peers. Before medical school, I spent a summer preparing administrative paperwork for Institutional Review Board (IRB) approval, I collected documents and signatures, reviewed protocols for clinical trials, followed-up with patients on their ability to continue with studies and scheduled appointments.
Each encounter with research in a clinical setting has required me to complete research-specific certification on the Health Insurance Portability and Accountability Act (HIPPA) and the Human Subjects Protection Training. The required reading includes the Nuremberg Code, the World Medical Association’s Declaration of Helsinki and the Belmont Report. Furthermore, reading about the gravity of inhumane experimentation in the Tuskegee study along with many documented, but not so famous cases sheds light where “the lack of informed consent, deception, withholding information, withholding available treatment, putting [patients] and their families at risk, exploitation of a vulnerable group of subjects who would not benefit from participation” are evident and harmful. Civil rights leader and educator Dr. Dorothy Height served on the National Belmont Commission that developed the basis for regulations known as Common Rule 45 CFR part 46 defining the boundaries between practice and research with a code for ethical principals based on respect for persons, beneficence, and justice.
The most popular summer reading among my medical humanities colleagues is The Immortal Life of Henrietta Lacks by Rebecca Skloot. It’s the story of HeLa cells starting with the life of the donor Henrietta Lacks, an African American woman with cervical cancer who in the 1950s came to Johns Hopkins seeking medical care. Predating IRBs and ethical guidelines there was no mandate for the protection of the use of Lacks cells by physician-scientist George Otto Gey and his colleagues from around the world. Remarkably, Henrietta Lacks’ (named HeLa) cell line led to the discovery of vaccine development, molecular biology techniques including cloning, gene mapping applying scientific research for the advancement of medicine. I first came to know the immortal HeLa cell line in medical genetics when I did a poster presentation about Henrietta Lacks for the class. While some had worked with HeLa cells, no one had heard of Lacks or the unique history the immortal cell line. This story offers the opportunity for contemporary questions and discussions about biomedical research, health disparities, ethics and health policies.
The role of IRBs in research is now on the table for review with major revisions proposed to the Common Rule. High-volume research, technology, global collaborations among medical and academic centers as well as biomedical corporations drive the need for new guidelines and practices in research that will continue progress and benefit society.
Katherine Ellington is a medical student who blogs at World House Medicine.
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