Dr. Vytis Kazlauskas / © FM archive
Dr. Vytis Kazlauskas is a surgeon at the Children’s Hospital of Vilnius University Hospital Santaros Klinikos (VUH SK), who defended his dissertation on the topic The Role of Non-invasive, Minimally Invasive and Molecular Methods in the Diagnosis of Congenital Obstructive Uropathies for his PhD in Medicine. We are talking with the doctor about his doctoral studies experience at the Faculty of Medicine of Vilnius University (VU FM).
Tell us more what your PhD thesis was about?
The aim of my research was to determine how effective non-invasive diagnostic methods (those that do not enter the body) could be when diagnosing renal obstruction in congenital hydronephrosis and whether they could replace other popular invasive diagnostic methods. In my thesis, non-invasive diagnostic methods were considered to be renal ultrasound and urine biochemistry (that do not require venous catheterisation, general anaesthesia or the use of ionising radiation), while invasive tests were considered to be renal scintigraphy, magnetic resonance urography, intravenous urography, and computed tomography and have all of the disadvantages listed above. Subjects underwent one of the invasive diagnostic tests according to the standard guidelines for the pathology, and also a renal ultrasound was performed and a urine sample taken for biochemical analysis. Statistical computational methods were used to determine how accurately the non-invasive tests predicted the results of the invasive tests and how accurately the non-invasive tests predicted the need for surgery in the subjects.
What is the relevance of your thesis to the broader society?
The results of my thesis suggest the possibility of reducing the use of invasive testing for congenital obstructive hydronephrosis in children, thus avoiding the adverse effects of this testing on young children. The elimination of invasive diagnostic methods, which are technologically more complex and costly, could also improve the availability of obstructive hydronephrosis testing in smaller medical settings, where sophisticated diagnostic equipment is in short supply.
Doctoral studies are not an easy “adventure”. Tell us more about the challenges you faced while writing your dissertation. Despite these, what motivated you?
The main difficulty was the subjects of the thesis, which in my case were toddlers and children. Although the number of planned tests per person was small, even performing such tests as ultrasound and taking a urine sample turned out not to be that straightforward: it took time to understand the nuances of how to do this quickly and efficiently in children. It took time to get the hang of it, which came naturally through a few failures and the analysis of my own errors. Organising the transportation and storing the collected urine samples also required a lot of effort and was my sole responsibility. Of course, I could not have managed without the help of other staff members who kindly agreed to store the samples in the laboratory and to carry out the subsequent biochemical tests.
The main motivation was the first diagnostic testing results: once you have the initial data, you can make preliminary calculations. Then there is a feeling that some of the work has been done, and there is a sense of moving forward, collecting more data, seeing how the result changes as sampling ranges change. Of course, if the initial data collection process takes a long time and you cannot see the first results for a long time, it is somewhat demotivating. I would therefore recommend starting tests as early as possible, identifying the main inclusion criteria and continuing from there. I would also advise against planning tests with very strict inclusion criteria, especially in the case of a monocentric study. Strict inclusion criteria would lead to a really small sample size, which would not inspire you to move forward – it will take a long time and you still won’t have the results. Alternatively, in the course of the research, if the sample is deemed to be sufficient, it is possible to carry out the calculations using that sample and stricter criteria, but at the beginning of the research, you should try to include as many subjects as possible.
Also, as you know, doctoral studies in biomedicine require a bioethics clearance procedure and permits, which has nothing to do with conducting the research itself, but is very labour-intensive. I therefore recommend that you get permits for biomedical research as soon as possible.
What do you think a successful dissertation is?
It seems to me that the success of a dissertation depends very much on whether one wishes to understand the process of discovering science and try to replicate it oneself. The second most important aspect for motivation is the extent to which the dissertation topic is interesting to the doctoral student, and also whether the student sees the possibility of practical application. The technical aspects of the dissertation should not be overlooked: if the objectives of the dissertation do not match the possibilities, for example, if a rare problem is being examined, it will be difficult to collect the necessary sample to perform the calculations and to draw the conclusions over the 4 years of the studies. This can be a frustrating moment, which is why planning and a clear sense of whether the objectives are achievable, is essential.
Many people think that you have to be very clever to do research, but in my opinion, it’s all about passion and enthusiasm. In other words, if you really want to do it, you will clarify anything that you don’t understand or that is intimidating in any way. Some think that a PhD is a matter for “eternal” students, someone who is eternally young. If that is what you want, make sure to find a place for science in your life.
How has this experience shaped you as a person and as a scientist?
First of all, I had the opportunity to delve into the subject of obstructive hydronephroses, which I certainly would not have done so thoroughly had I not had to write my thesis. The second thing was to compare my own scientific experience and findings with those of other scientists, to know where I stand. Before doing research, when you read scientific articles everything can look like a very high level of scientific production. Without any research experience it is difficult to assess the level of scientific output, but having done the research, the calculations, and writing the article myself, I realised that the sample I had collected was not inferior in terms of quality or unique conclusions to the scientific output available on the subject. The quality of scientific output does not depend on the name of the researcher or the number of publications, but on the consistency, the input and the creative approach to the problem.
If you could turn back the clock, knowing what lies ahead, would you still repeat this experience of doctoral studies? Would you do anything differently?
I would certainly repeat it and would probably do everything the same, but with my current experience, I would try not to drop those few series of subjects that I lost at the beginning of my studies due to a lack of skills and a clear action plan.