Introducing the American Journal of Surgery Virtual Research Mentor: A primer for aspiring surgeon-scientists

Abstract

In recent years, the field of surgery has increasingly embraced the many ways to be productive as an academic surgeon. While earlier innovators such as Drs. Starzl and Folkman translated basic science research from the bench to the bedside, the term “academic surgery” today encompasses a much broader range of research domains – from making discoveries in a basic science laboratory to shaping surgical education to influencing health policy. Despite this progress, some students, trainees, and early career surgeons find that lack of mentorship in an area of interest, limited academic resources, and lagging misconceptions about the scope of surgical research can impede progress in launching an academic career. These issues may be improving with an increased focus on diverse research interests at some institutions and surgical societies but still contribute to persistent disparities in academic attainment for underrepresented groups.1Yehia B.R. Cronholm P.F. Wilson N. et al.Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds.BMC Med Educ. 2014 Feb 9; 14 (PubMed PMID: 24512599. Pubmed Central PMCID: PMC3922304. Epub 2014/02/12): 26Crossref PubMed Scopus (86) Google Scholar To address these challenges, the American Journal of Surgery (AJS) Student and Resident Scholars Research Delegation has created the AJS Virtual Research Mentor, a compilation of high-yield resources to help students, trainees, and surgeons jumpstart their academic progress. The editorials in this series aim to share important references used by researchers engaged in academic surgery and eliminate barriers to entry for those with limited local research support. In this first installment, we explore identification of a research niche among the increasingly diverse areas of investigation in surgery, pathways to gaining research expertise at any career stage, and pillars of success that underlie each academic pathway.The first step in launching an academic career is identifying a research niche in one or more area(s) of surgical research. In basic science research, pre-clinical questions are evaluated in a laboratory using in vivo or in vitro models (from cell or tissue culture to large animal models). This work forms the basis of scientific knowledge.2Brophy C.M. Basic science career development.Am J Surg. 2006; 192 (2006/08/01/): 267-269Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,3Goldstein A.M. Blair A.B. Keswani S.G. et al.A roadmap for aspiring surgeon-scientists in today's healthcare environment.Ann Surg. 2019 Jan; 269 (PubMed PMID: 29958227. Pubmed Central PMCID: PMC6298819. Epub 2018/06/30): 66-72Crossref PubMed Scopus (53) Google Scholar By contrast, clinical trials typically involve prospective evaluation of an intervention compared to a control in a study population. Trials can be used to assess treatments, technologies, and other interventions in a variety of settings and ultimately change clinical practice. Health services research (HSR) refers to a diverse array of research designs involving the study of health outcomes (e.g. biologic and patient-reported outcomes) and healthcare delivery (e.g. healthcare costs, disparities, variations) often using population-based databases and a wide range of analytic techniques.4Ghaferi A.A. Haider A.H. Kibbe M.R. Maximizing the impact of surgical health services research: the methodology toolbox.JAMA Surgery. 2020; 155: 190-191Crossref PubMed Scopus (7) Google Scholar Additional important research areas in surgery include but are not limited to medical education,5Palmquist E. Ricard C. Chen L. Review of surgical education research trends in north America.J Surg Educ. 2019 Nov - Dec; 76 (PubMed PMID: 31350223. Epub 2019/07/28): 1476-1483Crossref PubMed Scopus (4) Google Scholar health policy,6Massarweh N.N. Kelz R.R. From policy to patient care-the cycle of health policy research.JAMA Surg. 2019 Sep 1; 154 (PubMed PMID: 31268506. Epub 2019/07/04): 793-794Crossref PubMed Scopus (2) Google Scholar quality improvement and patient safety,7Institute of Medicine Committee on Quality of Health Care in ACrossing the Quality Chasm: A New Health System for the 21st Century.2001Google Scholar and global health.8Ferrada P. Sakran J.V. Dubose J. et al.Above and beyond: a primer for young surgeons interested in global surgery.Bull Am Coll Surg. 2017 Feb; 102 (PubMed PMID: 28925237. Epub 2017/09/20. eng): 33-38PubMed Google Scholar,9Saluja S. Nwomeh B. Finlayson S.R.G. et al.Guide to research in academic global surgery: a statement of the society of university surgeons global academic surgery committee.Surgery. 2018 Feb; 163 (PubMed PMID: 29221877. Epub 2017/12/10. eng): 463-466Abstract Full Text Full Text PDF PubMed Scopus (15) Google ScholarAfter identifying a research niche, it is important to build research expertise and develop an academic portfolio. The term “academic surgery” often evokes clinical expertise, research productivity, dedication to surgical education, and often involvement in administration or leadership.10Rosengart T.K. Mason M.C. LeMaire S.A. et al.The seven attributes of the academic surgeon: critical aspects of the archetype and contributions to the surgical community.Am J Surg. 2017; 214: 165-179Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar These broad categories often serve as the framework for promotion and tenure evaluation across academic institutions. One commonly held misconception, however, is that there is a single pathway for becoming a surgeon-scientist. In fact, academic surgery is now defined more by the diversity of those who enter and their interests than ever before.11Butler P.D. Pugh C.M. Meer E. et al.Benchmarking accomplishments of leaders in American surgery and justification for enhancing diversity and inclusion.Ann Surg. 2020 Dec; 272 (PubMed PMID: 32649466. Epub 2020/07/11): 897-903Crossref PubMed Scopus (14) Google Scholar Benchmarking studies of leaders in academic surgery demonstrate that a diverse set of training pathways can lead to successful academic careers.11Butler P.D. Pugh C.M. Meer E. et al.Benchmarking accomplishments of leaders in American surgery and justification for enhancing diversity and inclusion.Ann Surg. 2020 Dec; 272 (PubMed PMID: 32649466. Epub 2020/07/11): 897-903Crossref PubMed Scopus (14) Google Scholar,12Hughes B.D. Butler P.D. Edwards M.A. et al.The Society of Black Academic Surgeons CV benchmarking initiative: early career trends of academic surgical leaders.Am J Surg. 2020; 219: 546-551Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The most common pathway involves one to three years of dedicated academic development time during residency at an institution with research infrastructure and a national presence to support burgeoning academic intentions. This time can be used to pursue advanced degrees, network with leaders in a specialized research area, and gain experience publishing and presenting mentored research. The availability of funding for academic pursuits may inform decisions about the timing and pursuit of additional research training. Fortunately, mentored research and advanced degree programs can be pursued at multiple time points – during or after undergraduate studies, during medical school, or even during clinical practice (Fig. 1).A few key pillars of success underlie any pathway to academic surgery. First is a fundamental understanding of the scientific process, which ensures that research skills are employed to address meaningful research questions. Many academic medical centers have dedicated centers for basic, clinical and translational research which can help develop those skills (e.g. National Institutes of Health Clinical & Translational Science Award programs). Because these centers are limited in number and not accessible to all trainees, many professional surgical organizations have developed excellent career development resources to address these gaps. The second pillar of surgical research is mentorship. A good mentor should show genuine interest and investment in a trainee's academic progress and provide access to the skills and resources they need to meet their research goals. Good mentees communicate clearly with their mentors, follow through on research commitments and seek opportunities to further develop as a surgeon scientist. Mentorship can be identified at one's own institution or through professional organizations.13Kovler M.L. Hackam D.J. Choosing a good scientific mentor and being a good mentee.in: Kennedy G. Gosain A. Kibbe M. LeMaire S.A. Success in Academic Surgery: Basic Science. Springer International Publishing, Cham2019: 13-20Crossref Google Scholar The third pillar of surgical research is securing funding, which can be obtained through academic institutions, surgical societies, national research agencies, and foundation grants (Table 1). The process of applying for funding forces researchers to hone their research questions and communicate their research effectively. Early funding opportunities as a student, trainee, or early career surgeon can serve as a springboard for success at later career stages.14Langston R.G. Zhao E.H. Wong K.H. Rodriguez A. Recent trends in NIH funding for top surgeon-scientists.Am J Surg. 2020 Dec 4; (PubMed PMID: 33309253. Epub 2020/12/15. eng)PubMed Google ScholarTable 1Resources for embarking upon a career in academic surgery.Pillar of SuccessResourceUnderstanding the Scientific ProcessKennedy G, Gosain A, Kibbe M, LeMaire SA, eds. Success in Academic Surgery: Basic Science. 2nd edition. Springer International Publishing; 2019.Pawlik TM, Sosa JA, eds. Success in Academic Surgery: Clinical Trials. 2ndedition. Springer International Publishing; 2020.Dimick JB, Lubitz CD, eds. Success in Academic Surgery: Health Services Research. 2nd edition. Springer International Publishing; 2020.Kelz R, Wong S, eds. Success in Academic Surgery: Surgical Quality Improvement. Springer international Publishing; 2017.MentorshipThe Association of Women Surgeons. The AWS Coaching Project. 2018Professional organizations (e.g. Association for Academic Surgery, Association of Women Surgeons, Society of Black Academic Surgeons, etc.)Mentorship opportunities at your institution and regional medical/surgical societiesSecuring FundingAssociation for Academic Surgery Resident Research Funding Primer 2021Association for Academic Surgery Resident Research Funding OpportunitiesAAMC Grants and Fellowships Supplement [database on the Internet]. 2014 [cited 3/29/2021]American College of Surgeons ScholarshipsLocal funding resources at your institution Open table in a new tab This first issue of the AJS Virtual Research Mentor describes the skills that form the foundation of any career as a surgeon scientist. The series will ultimately aim to demystify the practical aspects of academic surgery, paving the way for a wider array of aspiring surgeon-scientists to make contributions to the field. Future issues will address fundamental aspects of research including building a curriculum vitae, identifying the correct analytic technique for various types of research questions, and effectively communicating research findings through presentations and publications. In recent years, the field of surgery has increasingly embraced the many ways to be productive as an academic surgeon. While earlier innovators such as Drs. Starzl and Folkman translated basic science research from the bench to the bedside, the term “academic surgery” today encompasses a much broader range of research domains – from making discoveries in a basic science laboratory to shaping surgical education to influencing health policy. Despite this progress, some students, trainees, and early career surgeons find that lack of mentorship in an area of interest, limited academic resources, and lagging misconceptions about the scope of surgical research can impede progress in launching an academic career. These issues may be improving with an increased focus on diverse research interests at some institutions and surgical societies but still contribute to persistent disparities in academic attainment for underrepresented groups.1Yehia B.R. Cronholm P.F. Wilson N. et al.Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds.BMC Med Educ. 2014 Feb 9; 14 (PubMed PMID: 24512599. Pubmed Central PMCID: PMC3922304. Epub 2014/02/12): 26Crossref PubMed Scopus (86) Google Scholar To address these challenges, the American Journal of Surgery (AJS) Student and Resident Scholars Research Delegation has created the AJS Virtual Research Mentor, a compilation of high-yield resources to help students, trainees, and surgeons jumpstart their academic progress. The editorials in this series aim to share important references used by researchers engaged in academic surgery and eliminate barriers to entry for those with limited local research support. In this first installment, we explore identification of a research niche among the increasingly diverse areas of investigation in surgery, pathways to gaining research expertise at any career stage, and pillars of success that underlie each academic pathway. The first step in launching an academic career is identifying a research niche in one or more area(s) of surgical research. In basic science research, pre-clinical questions are evaluated in a laboratory using in vivo or in vitro models (from cell or tissue culture to large animal models). This work forms the basis of scientific knowledge.2Brophy C.M. Basic science career development.Am J Surg. 2006; 192 (2006/08/01/): 267-269Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,3Goldstein A.M. Blair A.B. Keswani S.G. et al.A roadmap for aspiring surgeon-scientists in today's healthcare environment.Ann Surg. 2019 Jan; 269 (PubMed PMID: 29958227. Pubmed Central PMCID: PMC6298819. Epub 2018/06/30): 66-72Crossref PubMed Scopus (53) Google Scholar By contrast, clinical trials typically involve prospective evaluation of an intervention compared to a control in a study population. Trials can be used to assess treatments, technologies, and other interventions in a variety of settings and ultimately change clinical practice. Health services research (HSR) refers to a diverse array of research designs involving the study of health outcomes (e.g. biologic and patient-reported outcomes) and healthcare delivery (e.g. healthcare costs, disparities, variations) often using population-based databases and a wide range of analytic techniques.4Ghaferi A.A. Haider A.H. Kibbe M.R. Maximizing the impact of surgical health services research: the methodology toolbox.JAMA Surgery. 2020; 155: 190-191Crossref PubMed Scopus (7) Google Scholar Additional important research areas in surgery include but are not limited to medical education,5Palmquist E. Ricard C. Chen L. Review of surgical education research trends in north America.J Surg Educ. 2019 Nov - Dec; 76 (PubMed PMID: 31350223. Epub 2019/07/28): 1476-1483Crossref PubMed Scopus (4) Google Scholar health policy,6Massarweh N.N. Kelz R.R. From policy to patient care-the cycle of health policy research.JAMA Surg. 2019 Sep 1; 154 (PubMed PMID: 31268506. Epub 2019/07/04): 793-794Crossref PubMed Scopus (2) Google Scholar quality improvement and patient safety,7Institute of Medicine Committee on Quality of Health Care in ACrossing the Quality Chasm: A New Health System for the 21st Century.2001Google Scholar and global health.8Ferrada P. Sakran J.V. Dubose J. et al.Above and beyond: a primer for young surgeons interested in global surgery.Bull Am Coll Surg. 2017 Feb; 102 (PubMed PMID: 28925237. Epub 2017/09/20. eng): 33-38PubMed Google Scholar,9Saluja S. Nwomeh B. Finlayson S.R.G. et al.Guide to research in academic global surgery: a statement of the society of university surgeons global academic surgery committee.Surgery. 2018 Feb; 163 (PubMed PMID: 29221877. Epub 2017/12/10. eng): 463-466Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar After identifying a research niche, it is important to build research expertise and develop an academic portfolio. The term “academic surgery” often evokes clinical expertise, research productivity, dedication to surgical education, and often involvement in administration or leadership.10Rosengart T.K. Mason M.C. LeMaire S.A. et al.The seven attributes of the academic surgeon: critical aspects of the archetype and contributions to the surgical community.Am J Surg. 2017; 214: 165-179Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar These broad categories often serve as the framework for promotion and tenure evaluation across academic institutions. One commonly held misconception, however, is that there is a single pathway for becoming a surgeon-scientist. In fact, academic surgery is now defined more by the diversity of those who enter and their interests than ever before.11Butler P.D. Pugh C.M. Meer E. et al.Benchmarking accomplishments of leaders in American surgery and justification for enhancing diversity and inclusion.Ann Surg. 2020 Dec; 272 (PubMed PMID: 32649466. Epub 2020/07/11): 897-903Crossref PubMed Scopus (14) Google Scholar Benchmarking studies of leaders in academic surgery demonstrate that a diverse set of training pathways can lead to successful academic careers.11Butler P.D. Pugh C.M. Meer E. et al.Benchmarking accomplishments of leaders in American surgery and justification for enhancing diversity and inclusion.Ann Surg. 2020 Dec; 272 (PubMed PMID: 32649466. Epub 2020/07/11): 897-903Crossref PubMed Scopus (14) Google Scholar,12Hughes B.D. Butler P.D. Edwards M.A. et al.The Society of Black Academic Surgeons CV benchmarking initiative: early career trends of academic surgical leaders.Am J Surg. 2020; 219: 546-551Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The most common pathway involves one to three years of dedicated academic development time during residency at an institution with research infrastructure and a national presence to support burgeoning academic intentions. This time can be used to pursue advanced degrees, network with leaders in a specialized research area, and gain experience publishing and presenting mentored research. The availability of funding for academic pursuits may inform decisions about the timing and pursuit of additional research training. Fortunately, mentored research and advanced degree programs can be pursued at multiple time points – during or after undergraduate studies, during medical school, or even during clinical practice (Fig. 1). A few key pillars of success underlie any pathway to academic surgery. First is a fundamental understanding of the scientific process, which ensures that research skills are employed to address meaningful research questions. Many academic medical centers have dedicated centers for basic, clinical and translational research which can help develop those skills (e.g. National Institutes of Health Clinical & Translational Science Award programs). Because these centers are limited in number and not accessible to all trainees, many professional surgical organizations have developed excellent career development resources to address these gaps. The second pillar of surgical research is mentorship. A good mentor should show genuine interest and investment in a trainee's academic progress and provide access to the skills and resources they need to meet their research goals. Good mentees communicate clearly with their mentors, follow through on research commitments and seek opportunities to further develop as a surgeon scientist. Mentorship can be identified at one's own institution or through professional organizations.13Kovler M.L. Hackam D.J. Choosing a good scientific mentor and being a good mentee.in: Kennedy G. Gosain A. Kibbe M. LeMaire S.A. Success in Academic Surgery: Basic Science. Springer International Publishing, Cham2019: 13-20Crossref Google Scholar The third pillar of surgical research is securing funding, which can be obtained through academic institutions, surgical societies, national research agencies, and foundation grants (Table 1). The process of applying for funding forces researchers to hone their research questions and communicate their research effectively. Early funding opportunities as a student, trainee, or early career surgeon can serve as a springboard for success at later career stages.14Langston R.G. Zhao E.H. Wong K.H. Rodriguez A. Recent trends in NIH funding for top surgeon-scientists.Am J Surg. 2020 Dec 4; (PubMed PMID: 33309253. Epub 2020/12/15. eng)PubMed Google Scholar This first issue of the AJS Virtual Research Mentor describes the skills that form the foundation of any career as a surgeon scientist. The series will ultimately aim to demystify the practical aspects of academic surgery, paving the way for a wider array of aspiring surgeon-scientists to make contributions to the field. Future issues will address fundamental aspects of research including building a curriculum vitae, identifying the correct analytic technique for various types of research questions, and effectively communicating research findings through presentations and publications.