When applying to general surgery residency, I remember the most common question posed at residency Q&A sessions: “Are dedicated research years required?”. More often than not, academic programs answered with some variation of, “Usually… but not always”. The concern among medical students entering the field of surgery is valid; 5 years at a resident’s salary during the prime of your life is different than 6-8 years. The opportunity cost of delaying attending wages while in research has been estimated to range from $868,000 to over two million for two years, with greater cost in fields with integrated training programs such as vascular surgery or cardiothoracic surgery1. As the requirements for successful matriculation continue to increase for competitive specialties, the percentage of medical students taking dedicated research time prior to applying also continues to increase. With more and more time spent in research, this begs the question, what is the value of dedicated research time?
Academically, taking dedicated research time has been shown to increase the likelihood of faculty appointment and federal grant funding2,3, with MD/PhDs having the greatest likelihood of future funding2,4,5. While future funding is important for those academically inclined, it may not be the best measure of value to the individual. Is the experience of research time away from clinical practice meaningful if NIH funding is not your ultimate goal? In a 2007 study, Robertson et al. surveyed 75 practicing surgeons, of which 66 had taken dedicated research time during their residency training3. Fifty-one of the 75 went on to continue to perform research in their career. Respondents generally felt their research training was worthwhile with no significant difference in perceived value regardless of their current type of practice. This suggests that the value of dedicated research extends beyond the research itself.
My belief is that the research years away from clinical duties help to mature residents in two fundamental ways: as clinicians and as individuals. Protected research time away from clinical practice is typically taken after 2-3 clinical years of training, when the trainee understands postoperative care and has developed their own set of clinical questions based on their experience. Research gives residents the opportunity to learn the nuances of study design, craft a project to answer their clinical questions, and execute a study that hopefully yields an answer. A deep understanding of study design provides residents not only a way to answer research questions but also the ability to critically evaluate published literature. In time, this skill helps surgeons refine their clinical practice over the course of their careers as our understanding of diseases improves. It is also during this time that many begin to establish their future academic niche and establish both network and mentoring connections. The skillsets acquired are complementary to what we learn during our clinical years and help shape a well-rounded clinician.
Personal development while in research occurs in a large part due to the timing. It comes at a pivotal time in a trainee’s life where they can evaluate what is important outside of the extrinsic pressures of clinical duties. There’s an inclination amongst surgeons to take on the most difficult tasks, work hard and stay late, often at the detriment of our personal lives and relationships. While residencies have placed increased emphasis on resident wellness in the past decade, clinical care will almost always afford less flexibility than research. The time away from clinical pressure allows surgical trainees to fully consider what sort of career they want, whether that be operating long hours, performing research, all of the above, or none of the above. It is important that residents enter into their future careers fully confident of their decisions leading up to that point. A side-effect of the extra time for introspection is that a significant portion of residents leave surgical training. While attrition is unfortunate, the alternative of someone pushing through to enter a career they don’t truly want is more ill-fated. For others, the research years reaffirm their desire to be a surgeon. From my own research experience, I changed my fellowship trajectory and along the way made lifelong friends and grew my family. I returned to residency with a new dedication and enjoyed my final two years more than the previous years.
Despite advocating the benefits of dedicated research time, I understand that it is not for everyone. There’s a significant proportion of surgical residents for whom the opportunity cost is not worth it. Many have already spent significant time doing research such as MD/PhDs or entered the field of medicine later in life. Therefore, it is important that programs have the flexibility to tailor their training to the trainee. While the question asked may be, “Are dedicated research years required?”, what it really means is, “Is your program able to tailor the training to my goals?”. It is an important question that should be asked at residency interviews. Dedicated research time is a considerable cost, but for many, it is worth the price.
1 Dewane, M. P., Thomas, D. C., Longo, W. E. & Yoo, P. S. Paying the Price: Understanding the Opportunity Cost of Dedicated Research Time during Surgical Training. The American Surgeon 84, 1723-1726, doi:10.1177/000313481808401125 (2018).
2 Andriole, D. A., Klingensmith, M. E., Fields, R. C. & Jeffe, D. B. Is Dedicated Research Time During Surgery Residency Associated With Surgeons’ Future Career Paths?: A National Study. Ann Surg 271, 590-597, doi:10.1097/sla.0000000000003015 (2020).
3 Robertson, C. M., Klingensmith, M. E. & Coopersmith, C. M. Long-term outcomes of performing a postdoctoral research fellowship during general surgery residency. Ann Surg 245, 516-523, doi:10.1097/01.sla.0000245468.98852.42 (2007).
4 Harding, C. V., Akabas, M. H. & Andersen, O. S. History and Outcomes of 50 Years of Physician-Scientist Training in Medical Scientist Training Programs. Acad Med 92, 1390-1398, doi:10.1097/acm.0000000000001779 (2017).
5 Jeffe, D. B. & Andriole, D. A. Prevalence and predictors of US medical graduates’ federal F32, mentored-K, and R01 awards: a national cohort study. J Investig Med 66, 340-350, doi:10.1136/jim-2017-000515 (2018).