Publish or Perish: The Research Arms Race in Residency Selection

Identifying the Next Generation of Academic Surgeons and Physician Leaders

Many highly competitive academic general surgery residency programs share the mission of training the next generation of academic surgeons. There is a widely held belief that encouraging publications throughout residency will promote sustained research productivity and facilitate a pathway into an academic career. Consequently, the total number of publications is one of the strongest predictors for resident selection among top ranked general surgery programs. However, there is currently a lack of evidence supporting the assumptions that preresidency productivity will be sustained or predictive of an academic career. With an increasingly competitive applicant pool and recent paradigm shifts in the evaluation of applicants, it is becoming increasingly important for program directors to identify meaningful metrics to predict sustained academic success and successful academic surgeons. We discuss current trends in the evaluation of applicants' research, limitations of these methods, potential implications, and alternatives.

Scholarly impact of student authorship in urology research

BACKGROUND

H-index is an indicator of research productivity considered in faculty promotion. We examine trends in female authorship and effect of student authorship on H-index of principal investigators (PI).

METHODS

Author gender, degree, designation as student, PI, or other, were recorded from Journal of Endourology from 2011 to 2020. PI Scopus H-index was recorded. PIs were classified into having student authors (SA) or not (nSA). Analysis conducted with IBM SPSS.

RESULTS

Of 819 total articles, 26 ​% had SA. Articles with SAs increased from 22.2 ​% in 2011 to 31.1 ​% in 2020 (p for trend<0.01). There was an increasing trend in female authorship overall (R2 ​= ​0.84). PIs with SA had a significantly higher mean H-index than those without, across all years (SA ​= ​30.91, nSA ​= ​27.45, p ​= ​0.025).

CONCLUSIONS

Student authorship is increasing and positively benefits PI H-index. Female authorship is increasing overall within urology. Encouraging mentorship and student research can enhance and support female student interest in urology.

Publication of Medical Student Summer Research: A Multi-institutional Analysis

Objective

Summer research programs can support medical students' exposure to research and scholarly activity, and strengthen their applications for residency positions, particularly if students are able to generate peer-reviewed publications resulting from their summer experience. We aimed to estimate the rate of publication among medical student summer projects and identify any predictors of projects' progress to publication.

Methods

Projects were identified from abstract books published by five medical schools' summer research programs for rising second-year medical students. Resulting publications were queried in PubMed, Scopus, and Google Scholar. Abstract characteristics were correlated with publication outcomes using bivariate analysis.

Results

We identified 158 eligible abstracts representing medical student summer research projects. Overall, 34% resulted in publication, but Kaplan-Meier analysis found that only one-quarter were published within 3 years of presentation (i.e., around the time of graduation from medical school). No abstract characteristics were associated with odds of any vs. no publication, and only disclosure of project funding was (negatively) associated with the hazard of publication.

Conclusions

Summer research programs fostering medical students' engagement in research may not directly lead to the publication of work completed during the program for most participants. Tracking the likelihood of publishing summer project results can help medical schools effectively advise students on how to maximize the utility of their participation in extracurricular research, without leading to burnout or disenchantment. Further research is needed to understand how connecting students and mentors with longitudinal support after the end of a summer program might facilitate project completion and publication.

The next generation of physician-researchers: undergraduate medical students' and residents' attitudes, challenges, and approaches towards addressing them

BACKGROUND

Undergraduate medical education and residency training are critical periods for conducting research. Medical diagnoses and therapies are direct results of successful research efforts that have advanced several scientific fields. This review highlights the importance of incorporating scientific research training into the curricula of undergraduate medical education and residency programs.

METHODS

We utilized key databases such as PubMed, Web of Science, and Google Scholar to conduct a narrative review of English-language articles published between 2002 and 2024. Ultimately, we selected 49 studies that examined the attitudes of undergraduate medical students and residents toward research, the common challenges they encounter while participating in research activities, and the strategies that support and encourage their involvement, all in alignment with our study objectives and keywords. In addition, we identified several relevant themes, including the value of research experience in shaping well-rounded medical professionals; the integrity of research practices in residency selection, which addresses concerns such as the arms race and misrepresentation, as well as the balance between quality and quantity; striking a balance between research and clinical training while promoting equity and inclusion; and effective programs and mentorship strategies to enhance research engagement.

RESULTS

Translating the positive attitudes of undergraduate medical students and residents into improved knowledge and practice necessitates the development of structured mentoring programs and advanced training systems. Institutions must provide the necessary tools, guidance, and support to overcome research barriers. This will help establish an environment in undergraduate medical education and residency training that values research, facilitates access to it, and integrates it into the curriculum.

CONCLUSIONS

To address the critical shortage of physician-researchers and improve evidence-based medical practice, it is crucial for medical schools to focus on research education and create avenues for student involvement. By tackling research challenges and implementing supportive strategies, these efforts empower the next generation of physician-researchers to embrace research, contribute to medical progress, and uphold the highest standards of patient care.

A Novel Urology Preliminary Residency Curriculum Within a Department of Surgery for Unmatched Applicants

OBJECTIVE

Traditional options for unmatched applicants in urology include pursuing a research fellowship or completing a preliminary general surgery training year. We aimed to create a novel urology-focused preliminary curriculum.

DESIGN

The general surgery program commits three preliminary positions for urology-focused interns. These interns complete six months of urology rotations and six months of general surgery rotations. Additionally, they are paired with a urology faculty member to participate in a longitudinal coaching and mentorship program.

SETTING

The curriculum is situated within a Department of Surgery, which includes the Division of Urology, at one academic institution.

PARTICIPANTS

Eight residents have completed the urology-focused preliminary curriculum in three academic years (2022-2023).

RESULTS

Six residents have obtained categorical urology positions. Four matched via the American Urological Association Urology Match into a post-graduate year 1 (PGY1) position, and two matched outside of a formal matching process into a PGY2 position.

CONCLUSION

This urology-focused preliminary curriculum presents a novel strategy to address the growing number of unmatched applicants in competitive surgical subspecialties such as urology.

PubMed-indexed Research Productivity of Urology Applicants and Residents: Does Medical Student Research Productivity Predict Resident Research or Pursuit of an Academic Career?

OBJECTIVE

To assess the research output of urology residents at top programs and investigate the correlation between medical school research productivity (MRP), research during residency (RRP), and pursuit of academic practice. Further, to characterize trends in MRP before and after the transition to pass/fail scoring of USMLE Step 1.

METHODS

Our team previously reported on the PubMed-indexed research productivity of applicants matching into top 50 urology programs. Here, we used the same list of residents, recorded their publications during residency, and noted their career paths, including fellowships, academic roles, or private practice. We then highlight the relationship between MRP, RRP, and pursuit of an academic career. We also highlight trends in MRP of applicants matching to top residency programs before and after the transition to pass/fail Step 1 exams.

RESULTS

We collected data on 727 residents. On multivariate logistic regression, total medical school publications (OR 1.07, 95% CI 0.97, 1.19), total urology publications (OR 1.05, 95% CI 0.92, 1.21), and total first author publications (OR 1.10, 95% CI 0.91, 1.33) were not associated with academic appointment after residency. On the other hand, RRP was correlated with pursuit of academics (1.08, 95% 1.03,1.14). MRP was significantly higher amongst applicants who applied with a pass/fail exam compared to those who did not.

CONCLUSION

MRP is not predictive of pursuing an academic career, but RRP is. There is a significant increase in average MRP of those matching to top urology programs after the transition to a pass/fail scoring system for Step 1.

Exploring the 6-year Trend in Dedicated Research Years among Integrated Plastic and Reconstructive Surgery Residents

Background

The plastic and reconstructive surgery (PRS) match has become more competitive with an emphasis on research productivity. With the transition of the US Medical Licensing Examination step 1 examination to pass-fail grading, alternative evaluation metrics for residency applications are needed. Our study provides a landscape of the incidence of research years amongst integrated PRS residents and the potential impacts of gender and race.

Methods

A retrospective study was conducted for all integrated PRS residents who matched between 2017 and 2022, using publicly available sources including residency websites, PubMed, Doximity, and social media. Demographics, educational background, and participation in a dedicated PRS research year were recorded.

Results

Among 993 residents across 85 accredited integrated PRS programs, 15.7% (156 of 993) took a research year, with a significant increase over 6 years (R 2 = 0.73, P = 0.019). The majority were men at 51.9%, and White at 53.5%, with underrepresented in medicine residents comprising 13.5%. A total of 73.1% came from a medical school with a home program, and 52.6% matched into a top 20 residency program. No significant difference was seen in the racial/ethnic or gender representation of residents who took a research year compared with all PRS applicants and active PRS residents.

Conclusions

Research years before applying to residency are becoming more common among integrated PRS residents. Research years are especially common with students who do not have a home program and may help them gain skills and access to mentorship that improves the likelihood of matching.

"Luck of the draw really": a qualitative exploration of Australian trainee doctors' experiences of mandatory research

BACKGROUND

Many medical trainees, prior to achieving specialist status, are required to complete a mandatory research project, the usefulness of which has been debated. The aim of this study was to gain an in-depth understanding of trainees' experiences and satisfaction of conducting such research projects in Australia.

METHODS

A qualitative descriptive approach was used. Semi-structured interviews with trainees were undertaken between May 2021 and June 2022. Australian medical trainees who had completed a research project as part of specialty training within the past five years were invited to participate. The purposive sample was drawn from participants in a survey on the same topic who had indicated interest in participating in an interview. Interviews explored trainees' overall experience of and satisfaction with conducting research projects, as well as their perceptions of research training, support, barriers, enablers, and perceived benefits. Interviews were transcribed verbatim and thematically analysed.

RESULTS

Sixteen medical doctors from seven medical colleges were interviewed. Trainee experience and satisfaction was highly variable between participants and was shaped by four factors: 1) trainees entered their specialty training with their own perspectives on the value and purpose of the research project, informed by their previous experiences with research and perceived importance of research in their planned career path; 2) in conducting the project, enablers including protected time, supervisor support and institutional structures, were vital to shaping their experience; 3) trainees' access to these enablers was variable, mediated by a combination of luck, and the trainees' own drive and research skill; and 4) project outcomes, in terms of research merit, learning, career benefits and impacts on patient care.

CONCLUSIONS

Trainee experiences of doing research were mixed, with positive experiences often attributed to chance rather than an intentionally structured learning experience. We believe alternatives to mandatory trainee research projects must be explored, including recognising other forms of research learning activities, and directing scarce resources to supporting the few trainees who plan to pursue clinician researcher careers.

Pedagogic Strategies and Contents in Medical Writing/Publishing Education: A Comprehensive Systematic Survey

Workshops or training sessions on medical writing and publishing exist worldwide. We aimed to evaluate published articles about such workshops and examine both the content and teaching strategies employed. We searched ISI Web of Science, Ovid EMBASE, ERIC, Ovid Medline, and the grey literature. We considered no language, geographical location, or time period limitations. We included randomized controlled trials, before-after studies, surveys, cohort studies, and program evaluation and development studies. We descriptively reported the results. Out of 222 articles that underwent a full-text review, 30 were deemed eligible. The educational sessions were sporadic, with researchers often developing their own content and methods. Fifteen articles reported teaching the standard structure of medical articles, ten articles reported on teaching optimal English language use for writing articles, nine articles discussed publication ethics issues, and three articles discussed publication strategies to enhance the chance of publication. Most reports lacked in-depth descriptions of the content and strategies used, and the approach to those topics was relatively superficial. Existing workshops have covered topics such as the standard structure of articles, publication ethics, techniques for improving publication rates, and how to use the English language. However, many other topics are left uncovered. The reports and practice of academic-teaching courses should be improved.

Institutional Diversity in the Selection Process for General Surgery Residency

This Viewpoint examines the challenges faced by students from diverse institutional backgrounds in pursuing academic surgery and recommends measures to promote institutional diversity by adopting a more holistic approach in the selection process for general surgery residency.

Clinical Research Primer for Medical Students: Overview and Illustrative Experiences

Background  The ability to participate in clinical scholarship is a foundational component of modern evidence-based medical practice, empowering improvement across essentially every aspect of clinical care. In tandem, the need for comprehensive exposure to clinical research has been identified as a critical component of medical student training and preparation for residency that is underserved by traditional undergraduate medical education models. The goal of the current work was to provide guidelines and recommendations to assist novice medical students in taking ownership of their research education. Methods  The Clinical Research Primer was composed from pooled research documents compiled by the study authors and our institutional neurosurgery student research group. The Primer was then structured as the natural evolution of a research project from its inception through the submission process. Results  We divided the foundational components of the Clinical Research Primer into seven domains, each representing a landmark in the development of a peer-reviewed study, and a set of skills critical for junior scholars to develop. These vital components included the following: pitching and designing clinical studies, developing a research workflow, navigating the Institutional Review Board, data collection and analysis, manuscript writing and editing, submission mechanics, and tracking research projects for career development. Conclusion  We anticipate that the tools included in the Clinical Research Primer will increase student research productivity and preparedness for residency. Although our recommendations are informed by our experiences within neurosurgery, they have been written in a manner that should generalize to almost any field of clinical study.