Majority of Most-Cited Articles in Top Plastic Surgery Journals Do Not Receive Funding

Application of the Relative Citation Ratio to Assess Common Characteristics of the Highest Impact Articles in Reconstructive Microsurgery

Background  The purpose of this review is to characterize themes among the five reconstructive microsurgery articles achieving the highest Relative Citation Ratios (RCRs) published in the past 20 years in the top journals. In doing so, researchers may be better informed on how to propose salient research questions to impact the field and understand future directions in plastic surgery. Methods  A cross-sectional study was conducted with articles published in the top three journals based on the Impact Factor: Plastic and Reconstructive Surgery, Journal of Reconstructive Microsurgery, and Annals of Plastic Surgery. A search strategy with controlled vocabulary and keywords was conducted in PubMed to extract all reconstructive microsurgery (RM) articles published between 2002 and 2020. A two-stage screening process to include only RM studies was performed, with a third reviewer moderating discordances. Articles' RCR data were extracted from the National Institutes of Health iCite. The top five articles with the highest RCRs were selected for analysis. Results  We identified three features reflecting educational and clinical trends within RM that might be representative of super-performance in plastic surgery journals. These include (1) relevance to high-yield techniques in RM such as tissue flap procurement, indications, and outcomes, (2) identification of gaps in current knowledge of these topics, and (3) use of media and algorithms to provide clear recommendations. Conclusion  Researchers hoping to have an impactful contribution should pose research questions that address these key themes. The RCR index is a valuable tool to appreciate performance within microsurgery literature and clinical trends within the field.

Climbing the Research Ladder: A 25-year Analysis of K-to-R Grant Conversion among Plastic Surgeons

Background

We evaluate the performance of plastic surgeons in converting National Institutes of Health K grants in early career to R grants intended for established investigators. We also investigate characteristics that may positively predict successful transition from K to R grants.

Methods

K08, K23, and R01 (or equivalent) grants awarded to plastic surgeons and physicians within the departments of ophthalmology, dermatology, and neurosurgery were collected. Analyses of successful conversion rates from a K to an R grant between plastic surgeons and physicians within the selected departments were performed. Cross-sectional analysis of characteristics among identified plastic surgeons was completed via logistic regression to elucidate possible predictors of successful conversion.

Results

Comparison of pathway initiation rates demonstrate that plastic surgeons receive significantly fewer K grants relative to the size of their field when compared with other specialties (all P < 0.01). Of the analyzed plastic surgeons, 52.9% successfully converted to an R-series grant within 5.4 years of beginning their K-series grant. Conversion rates were not significantly different between plastic surgeons and physicians within the selected departments. Logistic regression analyses revealed that the time-adjusted mean relative citation ratio of K series-associated publications is a positive predictor of successful conversion (P = 0.047).

Conclusions

With regard to increasing National Institutes of Health funding via the K-to-R pathway, we believe the field of plastic surgery could benefit from an increased effort to pursue a pathway of K-to-R conversion with a focus on quality over quantity when publishing articles associated with a K-series grant.

Level of evidence in high impact surgical literature: the way forward

Evidence-based medicine stipulates that clinical decision-making should revolve around scientific evidence. The goal of the present study is to evaluate the methodological quality of surgical research recently published in JAMA Surgery, International Journal of Surgery, and British Journal of Surgery, the three surgical journals with the highest impact factor. An electronic search of the PUBMED database was performed to retrieve all articles published in the JAMA Surgery, International Journal of Surgery, and British Journal of Surgery in the year 2022. Three authors independently reviewed all retrieved articles and methodological designs of the publications were analyzed and rated using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence (Oxford Levels of Evidence scale). The initial search identified 1236 articles of which 809 were excluded after title and abstract screening. The remaining 427 underwent full text/methods read, of which 164 did not meet the inclusion/exclusion criteria. A total of 273 studies were included in the analysis. The average level of evidence was 2.5 ± 0.8 across all studies assessed. The majority of study designs were comprised of retrospective cohorts (n = 119), prospective cohorts (n = 47), systematic reviews of non RCTs (n = 39), and RCTs (n = 37). There was no significant difference in the average level of evidence between the top three journals (p = 0.50). Most clinical studies in the highest impact factor surgical journals are of level III evidence, consistent with earlier literature. However, our analysis demonstrates a relatively higher percentage of LOE I and II compared to what was previously published in the literature.

Revisiting Level of Evidence Ratings in Plastic Surgery: A Call to Action

BACKGROUND

Evidence-based medicine underpins medical and surgical practice, with level of evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted and appropriately interpret their conclusions, and more specifically the strength of their recommendations.

OBJECTIVES

The aim of this study was to reassess the LOE of articles published in plastic surgery journals.

METHODS

To assess the overall LOE of publications from January 1 to December 31, 2021, a review of the following plastic surgery journals was performed: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS), and Plastic and Reconstructive Surgery Global Open (PRS GO).

RESULTS

Of 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE 1 and 7.3% were LOE 2. Compared to past studies, PRS showed a significant LOE improvement (P = .0254), while ASJ and JPRAS saw nonsignificant changes; Annals experienced a significant decrease (P = .0092).

CONCLUSIONS

ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.

Recent Trends and Future Directions for the Integrated Plastic Surgery Match

The integrated plastic surgery residency match has risen to be the most competitive specialty in the 2022 match. This reality has prompted medical students to reach a high level of personal achievements, including pursuing research fellowships to boost research productivity. The competitive nature of this specialty has highlighted several barriers for applicants, such as those from groups underrepresented in surgery, of lower socioeconomic backgrounds, or without a home program. In recent years, there have been several changes to the match that stand to attenuate disparities among applicants, such as the transition to virtual interviews and the shift of the United States Medical Licensing Examination Step 1 score to pass-fail. The introduction of the Plastic Surgery Common Application and standardized letters of recommendation has altered the application process for the plastic surgery match. Given these recent trends, evaluating the current landscape and looking toward future directions for the integrated plastic surgery match becomes necessary. Understanding these changes will not only benefit medical students by giving them a transparent look into the match process but also provide a framework for other specialties to follow to increase accessibility to their specific specialty.

The Role of Dedicated Research Training in Promoting Academic Success in Plastic Surgery: Analysis of 949 Faculty Career Outcomes

This study aimed to analyze the association between completion of research training and career success in American plastic surgery faculty to aid trainees in their decisions to perform research fellowships.

Methods

A cross-sectional analysis of attending academic plastic surgeons in the United States was conducted. Outcomes were compared between faculty who completed research training (research fellowship, PhD, or MPH) and those who did not. Outcomes included promotion to full professor and/or department chair, h-index, and attainment of National Institutes of Health funding. Outcomes were analyzed using chi-squared tests, t tests, and multivariable regressions.

Results

A total of 949 plastic surgery faculty members were included, and of those, 185 (19.5%) completed dedicated research training, including 13.7% (n = 130) who completed a research fellowship. Surgeons who completed dedicated research training were significantly more likely to achieve full professorship (31.4% versus 24.1%, P = 0.01), obtain National Institutes of Health funding (18.4% versus 6.5%, P < 0.001), and have a higher mean h-index (15.6 versus 11.6, P < 0.001). Dedicated research fellowships were independently predictive of achieving full professorship (OR = 2.12, P = 0.002), increased h-index (β = 4.86, P < 0.001), and attainment of National Institutes of Health funding (OR = 5.06, P = 0.01). Completion of dedicated research training did not predict an increased likelihood of becoming department chair.

Conclusion

The performance of dedicated research training was predictive of improved markers of career success in plastic surgery and should be considered beneficial in both the short and long term.

[The Impact of Industrial Sponsorship on Research Findings in Randomised Clinical Trials in Plastic and Aesthetic Surgery: a Cross- Section Analysis of the Past 12 Years]

BACKGROUND

Industry funding of research studies can cause the results in the field of plastic, reconstructive and aesthetic surgery to be biased towards the sponsors. This paper aims to review randomised clinical trials (RCTs) published by leading international journals in plastic, reconstructive and aesthetic surgery with respect to characteristics and possible industry-friendly conclusions in favour of those funding the study.

MATERIAL AND METHODS

Characteristic data and funding of RCTs published by leading international plastic surgery journals from January 2010 to January 2022 were evaluated. The studies were categorised based on their thematic focus and the results in light of the existing funding.

RESULTS

A total of 381 RCTs were included in the analysis, 68.5% of which were from a university (n=261). The larger proportion of studies did not disclose any information about the research funding. While 26% (n=98) of the studies analysed were funded by companies, 9.7% (n=37) were funded by universities/the government (p<0.05, 95% confidence interval). The overall focus of private clinics was aesthetics (n=32). Generally, the topic aesthetics (n=153) was funded by industry in 28 of 100 cases (28% industry/private sponsors compared with 9% university/government). Regarding reconstruction/burns/hand surgery, 9.2% of studies were funded by companies/private sponsors. Funding for research by university-based institutions was industry-sponsored in 25% (n=64) of cases. Regarding industry-sponsored studies, 73% (n=71) of the results were product-friendly in their conclusion (p<0.05, 95% confidence interval) and placed their thematic focus on therapeutic drug/product application (n=50, 75%).

CONCLUSION

In terms of funding, industry and private sponsors take a leading role both in reconstruction and aesthetics. Nonetheless, the majority of the evaluated studies were not financed by the private sector. In cases where the research was funded by private companies, the results were significantly in favour of the product. Aesthetics as a focus is currently more frequently funded by industry than reconstruction, burn, and hand surgery.

The Impact of Senior Author Profile on Publication Level of Evidence in Plastic and Reconstructive Surgery

Plastic and Reconstructive Surgery (PRS) incorporated the level of evidence (LOE) pyramid in 2011 to highlight evidence-based medicine in plastic surgery. This study aimed to assess the relationship between the profile of senior authors publishing in PRS and the LOE of publications.

Does Diversity of Authorship Matter? An Analysis of Plastic Surgery's Top 100 Articles

Diversity, whether related to age, gender, ethnicity, race, geography, or experience, is increasing in all realms of medicine, including plastic surgery. Research has also become more diverse in those who conduct studies and those who participate in them. Fittingly, surgeons who produce prominent research are likely to come from diverse backgrounds. This study was designed to analyze the diversity of authorship in peer-reviewed plastic surgery journals.

A Primer for Success as an Early Career Academic Plastic Surgeon

The early career academic plastic surgeon strives to be an expert surgeon, an innovative researcher, and an impactful educator. Navigating these challenges is difficult in a healthcare landscape with diminishing public research funding, increasing demand from institutions for clinical productivity, and decreased value of surgical education. To help the junior academic plastic surgeon, this article discusses the fundamental aspects of developing an early academic plastic surgery practice, rooted in clinical care, research, and education.

METHODS

Using published literature, expert opinion, and faculty interviews, the authors prepared this primer for education and guidance of plastic surgery residents considering a career in academic plastic surgery and early career academic plastic surgeons.

RESULTS

This primer highlights elements important to succeeding as a junior academic plastic surgeon including defining goals and priorities, institutional and financial support, mentorship, education of students and residents, developing a practice niche, promotion and tenure, and social support and burnout.

CONCLUSION

The early career academic plastic surgeon can create an environment for academic success with appropriate institutional support, mentorship, personal, and social support, to progress toward promotion while minimizing burnout and professional exhaustion.

"A Sign of Things to Come: Training Research Output Long-Term Scholarship in Academic Plastic Surgery."

BACKGROUNDS

Academic plastic surgery has utilized different methods to promote early involvement of trainees in research. Further analysis is needed to characterize the effects of this early emphasis and their impact on long-term academic contributions to the field.

METHODS

In October 2020, a cross-sectional study of 949 faculty from US academic plastic surgery programs was conducted using publicly available websites. Training research output for each surgeon was compared to post-training research output and other metrics measuring sustained career scholarship.

RESULTS

Increased training publications (P< 0.0001) and citations (P< 0.0001) were associated with fewer years in practice. 727 surgeons (80.0%) had ≥ 1 research article, and this group proceeded to attain significantly higher mean post-training publications per year (3.04 ± 0.14 vs. 1.45 ± 0.13, P< 0.0001) and citations per year (72.12 ± 5.04 vs. 28.39 ± 3.49, P< 0.0001) compared to the 182 (20.0%) surgeons with no training publications. For individuals, total training publications were positively correlated with post-training publications per year (P< 0.0001), a relationship also observed for citations (P< 0.0001). When controlling for years in practice, increased training publications and/or citations were significantly associated with attaining academic professor track (versus clinical professor track) position, endowed professor status, journal board position, and NIH funding (P< 0.05 for all).

CONCLUSIONS

There is a trend of increasing research productivity during plastic surgery training, and increased training output is predictive of attaining multiple measures of career academic achievement. Academic plastic surgery should continue to underscore research participation as a valuable part of the training process.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .