Declining research interest among oncology residents: insights into the academic career from a nationwide longitudinal study in France

Nurturing a Research-active Clinical Oncology Workforce: A Trainee Perspective

Working as a physician in the 21st century is clearly a different endeavor compared to 50 or 100 years ago. Automation and digitalization in every part of modern work have fundamentally changed the medical sciences and clinical environments. The rise of artificial intelligence (AI) and deep machine learning will likely transform patient care and medical research in the near future. A recent study published in Nature Medicine showed that AI was as effective as junior pediatricians in detecting common pediatric diseases.1 In surgery, it is still unclear how far AI will be able to refine, accelerate, or even replace surgeons in their specialized fields. Albert Einstein once said: “Imagination is more important than knowledge. For knowledge is limited […]”. In the context of this modern technological revolution, imagination, and constant reinvention as surgeons seem more important than before. To proactively design the future of surgery, it is essential that surgeons become key players in novel and high-quality research. Historically, surgeons have been combining both clinical and research activities since the 1800s, as suggested by the term “surgeon-scientist.” Unfortunately, the quality of surgical research seems to be declining. In the New England Journal of Medicine, the proportion of surgical papers on the overall number of publications in the journal has been dropping dramatically since 1952.2 Even more concerning is the apparent shortage of young surgeons to design and conduct original research.3 A recent Nature editorial urged more surgeons to perform basic science as a response to a report that indicated that the number of surgeon-scientists has dramatically been decreasing.4,5 These negative developments in surgical research seem hazardous and conflicting with the upcoming drastic changes and innovations required to maintain a high level of performance in modern academic surgery. Woldu et al, consequently asked whether the surgeon-scientist is a dying breed.6 In this context, it is particularly unfortunate that the interest in research seems to decrease among young surgeons, resulting in the “extinction of surgeon-scientists.”7 Recently, the Basic Science Committee of the Society of University Surgeons published a roadmap to encourage and guide the next generation of surgeon-scientists towards their academic career.8 Doing a research fellowship can be an essential step on this roadmap for aspiring surgeon-scientists. Here we aimed to highlight the benefits of a research fellowship and the advantages it holds for an academic surgical career. Whether the aim of the trainee is to become a surgeon-scientist or not, performing a research fellowship will impact and strengthen the 3 pillars of a modern academic surgeon: clinical practice, research, and teaching. Individual outcomes of formal research training among general surgeons show a strong association of research time during residency and objective markers of long-term academic success.9 Surgeons that performed 1 year of research training had higher h-indices and were more likely to obtain National Institutes of Health funding later in their careers.9 Bobian et al reported that otolaryngology surgeons who had research training were more likely to achieve higher academic ranks, whereas clinical fellowships did not show this association.10 It seems intuitive that surgeons who perform research training are more likely to thrive in academic environments. Dedicated research training promotes research productivity and output. Surgeons that performed a 1-year research training had more first-author publications during residency, which objectifies their commitment to research and their ability to lead a project to completion.9 Being “extracted” from a clinical setting and put into a scientific environment might be an initially stressful and frustrating experience for a trainee but can eventually promote a unique and precious “out-of-the-box” thinking attitude. Research fellowships are often the trainee's first interaction with research, especially in Europe where medical students do not usually perform an undergraduate degree before entering medical school. Such research experiences prepare young surgeons for their work in academic centers. Given the worldwide ongoing centralization into large academic centers, young surgeons will benefit from such preparation. Research training will teach young surgeons how to distinguish low-quality from high-quality scientific work, how to read, evaluate, and criticize the scientific literature and how to put different scientific methodologies into perspective. Moreover, this experience will teach surgeons how to plan and manage projects and to understand what it takes to complete a project within a certain timeframe. Some academic centers offer opportunities to enroll into programs leading to a secondary degree such as the Doctorate, Master of Science, Master of Public Health, Master of Science in Public Health, or Master of Business Administration. Residents involved in such programs with coursework would receive formal research training on various aspects of research, such as methodology, ethics, and grant writing The impact of a research fellowship on the clinical mindset and performance – although difficult to objectify – can be significant. Dedicated time for research is the ideal ground for boosting creativity that can later be applied to both scientific and clinical practice. The time and freedom required for creativity will render visionary and innovative strategic thinking. This time and freedom are not always available in a busy clinical environment. A more inquisitive mindset will help to shift one's perspective from the diagnosis and management of a disease towards questioning the underlying pathogenesis, facilitating bedside to bench research, as a first essential step to translate results from bench to bedside. Moreover, the extra time during training without calls and night shifts allows for new information to be processed and stored properly. To memorize knowledge and recall when necessary we need time. The opportunity to do exactly this and the freedom to take some time to reflect will likely enhance quality of life during those years.11 Throughout a research fellowship, trainees will be interacting with scientists, biologists, and students with different backgrounds. Whereas it is well-known that physicians, and even more so surgeons, tend to evolve in a tight community of similar personalities with similar backgrounds and training, a diverse research experience provides an ideal environment to improve communication skills. Clear communication is crucial in medicine. Patient outcomes depend on exact communication between physicians, nurses, patients, and caregivers. Also, good interaction can enhance work satisfaction among the involved professionals. It is essential for effective communication to express thoughts precisely and clearly. During research training, residents learn how to express their thoughts clearly and communicate complex data in an understandable way. For instance, scientific abstract and manuscript writing requires precise and concise summarizing of research findings. The preparation of a scientific presentation will train the resident to introduce their topic in a structured and logical way. Furthermore, learning how to present results from fundamental research will clearly enhance teaching skills. A scientific discussion educates trainees to defend their opinion but also to consider other valuable aspects. This enhances critical thinking skills which are important to acquire during research time. The constant interaction with other researchers fosters scientific thinking, that can be used for research design and hypothesis. The underlying scientific motto postulated by Karl Popper in his “Logic of Scientific Discovery” was the attempt to falsify one's own hypothesis. This constant reflection on hypothesis, results, and their interpretation will practice critical thinking, that in turn enables young surgeons to question dogmas in the clinical arena and position them to develop innovative strategies to challenge these dogmas. Another positive effect of formal research training is access to the international surgical community. Meetings at scientific conferences not only provide young academic surgeons with the state-of-the-art knowledge in their field, but also nourishes relationships with other academic surgeons worldwide. Once introduced to the international scientific community, young surgeons will become part of this community which can boost their intrinsic motivation. This can broaden their horizon as a surgeon and a person and put opinions into perspective. These benefits do not apply only to the trainee, but also to the institutions and training programs. The reputation of an academic center with high quality research will help attract future students, residents, and fellows, but also maintain a certain level of expertise and expectation, resulting in further expansion of the academic mission. These institutions should aim to develop a culture where scientific activity is the “gold-standard” and not the exception. Therefore, dedicated and protected research time is essential and young academics who undergo research training are more likely to support this approach. Lifelong personal relations with mentors within academic institutions can foster ongoing scientific and personal mentorship. It is widely accepted that one requirement for a successful career in medicine is mentorship.8 During a research fellowship it is likely that, one will find a lifelong mentor with substantial experience to support and guide the resident's trajectory in a surgical career. Moreover, extra time for personal development under directly mentored supervision will not only help to become a better researcher, but also enhance skills like public speaking, writing, innovative thinking, and networking. In line with this, Mansukhani et al argue that the years spent in the laboratory should be rebranded as personal development time.12 Whereas most countries are aiming towards standardized surgical training programs, a research fellowship is the ideal time for a resident to enjoy some freedom in training and self-management. This may lead to discover a new interest for yet unexplored domains during the often rigid and standardized clinical training. Although in the US and Canada research fellowships are often undertaken before or during general surgical residency, this is still rather an exception for trainees in other countries. In the US and Canada, research fellowships help applicants to obtain a position for residency or clinical fellowship which is likely why there is more request to do research during their training. In most European countries, where surgeons often times start a subspecialty without prior training in general surgery, there is no such incentive to conduct research training. Another aspect concerns the costs of a formal research training program for residents and their absence in clinical training during that time. Who will pay or compensate for it? We believe that if we want to strengthen and improve academic surgery, we have to advocate for funding for young academic surgeons to participate in established research programs. As academic surgeons, we have to participate in the decision making on the allocation of research funds and be present in the respective review committees. Also, access to dedicated research time has to be without barriers for all academic surgeons. Equity, diversity, and inclusion need to be promoted in terms of opportunities to collaborate or issues in balancing family and work life. If we want to enhance surgical research performance, we have to guarantee equal opportunity to recruit the best possible faculty into academic surgery. Now that the benefits of performing a research fellowship have been well established, another crucial question is the timing of such an experience. We believe that early research exposure is essential to develop the abovementioned skills necessary for high quality research. A formal training early during residency will not only enhance the interest for the specialty but will allow the establishment of a critical and scientific mindset that the resident will be able to benefit from during his/her residency. More than ever, it is now undeniable that surgeons should invest more in (basic) science – a formal research training such as a research fellowship is the best starting point to do exactly this.

Previous authors have investigated many factors that predict an academic neurosurgical career over private practice, including attainment of a Doctor of Philosophy (PhD) and number of publications. Research has yet to demonstrate whether a master's degree predicts an academic neurosurgical career. This study quantifies the association between obtaining a Master of Science (MS), Master of Public Health (MPH), or Master of Business Administration (MBA) degree and pursuing a career in academic neurosurgery. Public data on neurosurgeons who had graduated from Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs in the period from 1949 to 2019 were collected from residency and professional websites. Residency graduates with a PhD were excluded to isolate the effect of only having a master's degree. A position was considered "academic" if it was affiliated with a hospital that had a neurosurgery residency program; other positions were considered nonacademic. Bivariate analyses were performed with Fisher's exact test. Multivariate analysis was performed using a logistic regression model. Within our database of neurosurgery residency alumni, there were 47 (4.1%) who held an MS degree, 31 (2.7%) who held an MPH, and 10 (0.9%) who held an MBA. In bivariate analyses, neurosurgeons with MS degrees were significantly more likely to pursue academic careers (OR 2.65, p = 0.0014, 95% CI 1.40-5.20), whereas neurosurgeons with an MPH (OR 1.41, p = 0.36, 95% CI 0.64-3.08) or an MBA (OR 1.00, p = 1.00, 95% CI 0.21-4.26) were not. In the multivariate analysis, an MS degree was independently associated with an academic career (OR 2.48, p = 0.0079, 95% CI 1.28-4.93). Moreover, postresidency h indices of 1 (OR 1.44, p = 0.048, 95% CI 1.00-2.07), 2-3 (OR 2.76, p = 2.01 × 10-8, 95% CI 1.94-3.94), and ≥ 4 (OR 4.88, p < 2.00 × 10-16, 95% CI 3.43-6.99) were all significantly associated with increased odds of pursuing an academic career. Notably, having between 1 and 11 months of protected research time was significantly associated with decreased odds of pursuing academic neurosurgery (OR 0.46, p = 0.049, 95% CI 0.21-0.98). Neurosurgery residency graduates with MS degrees are more likely to pursue academic neurosurgical careers relative to their non-MS counterparts. Such findings may be used to help predict residency graduates' future potential in academic neurosurgery.

There is increasing evidence that science & engineering PhD students lose interest in an academic career over the course of graduate training. It is not clear, however, whether this decline reflects students being discouraged from pursuing an academic career by the challenges of obtaining a faculty job or whether it reflects more fundamental changes in students’ career goals for reasons other than the academic labor market. We examine this question using a longitudinal survey that follows a cohort of PhD students from 39 U.S. research universities over the course of graduate training to document changes in career preferences and to explore potential drivers of such changes. We report two main results. First, although the vast majority of students start the PhD interested in an academic research career, over time 55% of all students remain interested while 25% lose interest entirely. In addition, 15% of all students were never interested in an academic career during their PhD program, while 5% become more interested. Thus, the declining interest in an academic career is not a general phenomenon across all PhD students, but rather reflects a divergence between those students who remain highly interested in an academic career and other students who are no longer interested in one. Second, we show that the decline we observe is not driven by expectations of academic job availability, nor by related factors such as postdoctoral requirements or the availability of research funding. Instead, the decline appears partly due to the misalignment between students’ changing preferences for specific job attributes on the one hand, and the nature of the academic research career itself on the other. Changes in students’ perceptions of their own research ability also play a role, while publications do not. We discuss implications for scientific labor markets, PhD career development programs, and science policy.

There is increasing evidence that science & engineering PhD students lose interest in an academic career over the course of graduate training. It is not clear, however, whether this decline reflects students being discouraged from pursuing an academic career by the challenges of obtaining a faculty job or whether it reflects more fundamental changes in students’ career goals for reasons other than the academic labor market. We examine this question using a longitudinal survey that follows a cohort of PhD students from 39 U.S. research universities over the course of graduate training to document changes in career preferences and to explore potential drivers of such changes. We report two main results. First, although the vast majority of students start the PhD interested in an academic research career, over time 55% of all students remain interested while 25% lose interest entirely. In addition, 15% of all students were never interested in an academic career during their PhD program, while 5% become more interested. Thus, the declining interest in an academic career is not a general phenomenon across all PhD students, but rather reflects a divergence between those students who remain highly interested in an academic career and other students who are no longer interested in one. Second, we show that the decline we observe is not driven by expectations of academic job availability, nor by related factors such as postdoctoral requirements or the availability of research funding. Instead, the decline appears partly due to the misalignment between students’ changing preferences for specific job attributes on the one hand, and the nature of the academic research career itself on the other. Changes in students’ perceptions of their own research ability also play a role, while publications do not. We discuss implications for scientific labor markets, PhD career development programs, and science policy.

Results of the 2004 Association of Residents in Radiation Oncology (ARRO) Survey

A CRASH! Response to COVID-19: reflections from the 2020 Roentgen Professorship

Burnout and Resiliency in Canadian Oncology Residents: A Nationwide Resident and Program Director Survey

Academic career development in surgical oncology in Germany faces multiple challenges. Young surgeons are confronted not only with high clinical workloads but also with a lack of structured support, funding opportunities, and transparent career pathways. At the same time, there is a strong interest in academic work and specialized training programs such as fellowships. The aim of this study was to assess the current state of training opportunities, interests, and needs of early-career surgeons in surgical oncology in order to derive targeted strategies to support their clinical and academic career development.An online survey covering career planning, research interests, structural support, and training needs was developed and distributed via surgical societies and networks for young surgeons across Germany. The results were analyzed quantitatively.A total of 191 individuals participated, with most working at university hospitals (45.1%) or tertiary care centers (28.0%). The main challenges reported were high clinical workload (82.4%) and lack of time for research (66.0%). A strong interest in specialized fellowships was expressed by 85.4% of respondents, particularly in colorectal, hepatobiliary, or pancreatic surgery. Mentorship (90.9%) and protected research time (77.6%) were deemed essential. Research interests primarily focused on clinical (81.5%) and surgical-technical research (62.3%). The establishment of topic-specific subgroups within a future Early Career Group (ECG)-such as clinical trials, robotics, or mentoring-was considered helpful by the majority.The findings highlight a clear interest in academic engagement among young surgeons and the urgent need for structured support. However, current clinical working conditions often hinder active scientific involvement. The gap between motivation and structural limitations underlines the necessity for targeted measures in training, mentoring, and research support. Despite high motivation, young surgeons in Germany frequently lack sufficient support for pursuing an academic career.

To report the percentage of resident graduates in the modern era who establish careers in academic radiation oncology 5 to 10 years after residency. The study population included 1147 radiation oncologists who completed residency between 2011 and 2017 and were practicing radiation oncologists in 2021. The percentage of 2011-2017 graduates with an academic career in 2021 (5 to 10y after residency): Holman Pathway resident: Yes, 74% versus No, 43% ( P <0.05); PhD degree before residency: Yes, 67% versus No, 38% ( P <0.05), Doximity top-10 ranked residency program: Yes, 66% versus No, 37% ( P <0.05).Logistic regression multivariate analysis confirmed PhD and Doximity top-10 as strong independent predictors for all endpoints.Regarding gender, no significant differences were observed for all 4 endpoints in the percentage of women versus men establishing academic careers at the 5-year to 10-year post-residency time point. Since 2011, at least one-third (~35%) of radiation oncology residents have gone into academic medicine and are academically productive 5 to 10 years after residency. Holman Pathway, PhD degree, or Doximity top-10 residency program approximately doubles the probability of an academic career. Moreover, radiation oncology is on track to achieve gender equity in academic medicine.

Relationship between Citation-Based Scholarly Activity of United States Radiation Oncology Residents and Subsequent Choice of Academic versus Private Practice Career

BackgroundThe full-scale Russian invasion of Ukraine, initiated on February 22, 2022, has created numerous challenges, including the need to study under the constant threat of bombardment. This study aimed to analyze the effects of the war on the academic performance of medical PhD students in Ukraine, explore their perceptions of stressful wartime events, and identify their motivations and future aspirations.MethodsThis mixed-method study included medical PhD students from Bogomolets National Medical University in Kyiv, Ukraine, during the 2022–2023 academic year amid ongoing Russian military attacks. Data were collected through self-completed questionnaires. Additionally, qualitative data were gathered via one-on-one interviews with participants. The questionnaire and interviews addressed educational difficulties during the war, motivation to pursue academic studies, the likelihood of continuing an academic or medical career in Ukraine, academic progress at the time of the survey, and self-assessed adaptation to studying during the war.Results108 PhD students participated in the questionnaire, and 53 were interviewed. Nearly half of the participants described their education as challenging. More than two-thirds experienced class disruptions due to air raid alarms or shelling, and a similar proportion resumed classes afterward. Among the PhD students, 85% envision their future careers as physicians, scientists, or teachers in Ukraine. Adaptation to the extraordinary conditions varied, with half adapting well. A substantial number remained motivated to pursue their education and professional careers in Ukraine despite financial strain, loss of research data, and damaged infrastructure, which hindered progress for some. Others struggled significantly, highlighting the war’s profound impact on their education and mental well-being.ConclusionWhile the war has imposed severe challenges on the educational pursuits of medical PhD students in Kyiv, Ukraine, the resilience displayed by many underscores their determination to persevere. This resilience reflects their commitment to their academic careers despite the adversities posed by the ongoing conflict. However, some students struggled to cope. Further psychological and financial support will be crucial in helping these students continue their studies and contribute to the rebuilding of their country.

1986 Association of residents in radiation oncology survey

Relevance of basic laboratory and clinical research activities as part of the vascular surgery fellowship: an assessment by program directors and postfellowship surgeons.

Association of preresidency peer-reviewed publications with radiation oncology resident choice of academic versus private practice career