Research in surgery – feasibility and myths 

Dr. Geeta Sundar 

Research is a cultivated art. Much like taste. Much like an ingrown passion. And it is not harnessed in one day, and it takes years and years to hone. Ask any Nobel Laureate and they will tell you that research is a dedication and that recognition comes served very old and cold. And they might also tell you that their mindful focus into their science was not for the results it would produce, but because it was what fuelled each morning’s rise.

Research is the very backbone of assumptions, of decisions in the medical field today. There is no foundation without research. Once a young surgeon is done with her/his residency, there are many decisions to make and roads to traverse – academic and research line, further studies and fellowships or private practice.

Each in-training-to-be-surgeon has already had some kind of research exposure in forms of literature review, thesis, publications, or having acquired a prior MPH. Those surgeons who wish to join an institution as a teacher/educator, after residency of fellowship, will have to keep pace with the required number of research articles to meet the demands of the department, year over year – easier said than done, of course. By stipulates according to certain governing bodies and institutions, an academic surgeon can only rise in the ropes of hierarchy by the number of papers, publications, mentoring he/she has done. As an assistant in a surgical department, handling and juggling between taking classes, teaching the interns, undergraduates, residents, fellows, operating, and having a clinical practice, with little to no financial support from the department is…a lot.

In addition to this, are the challenges in the methodology – adequate data collection often precluded, requirement of RCTs – as they are more authentic and accepted over case controls/case reports, blinding is futile, randomization poses problems and placebo as an intervention versus surgery is not possible. And the red tape that accompanies ethical considerations, ethics committee approval, funding, steep publication charges and logistics is time consuming and a hardship. Some surgeons lose their way in the midst of all the chaos and the happening, and are oftentimes lagging behind on their subscription for a better job offer due to the lack of enough publications. But for the others, research becomes a way of life, crisis management walks hand-in-hand with research studies.

There are many surgeons who manage to walk the talk, and run the mile – time management, compartmentalization, constant reading and keeping up to date with latest articles, mentoring and guiding students, inter-departmental rapports, writing books and contributing as authors for textbooks, delegation and hiring outside staff are just some of the ways they manage to cater to the needs for growing research. Their need to contribute and manifest affable research is more than just a drive, a passion, hard work and commitment.

On the other hand, those that enter private practice have much more relaxed timelines, deadlines of publications and their worth is measured by the clientele they bring in. The energy expenditure of a surgeon targets learning curves, newer techniques, building long term bonds with the patients and is narrowed far less on scientific studies. Research can exist on this side of the fence, but it is fewer in frequency, explained openly at conferences and on the back burner. Research at this level is more broadly expert’s opinions, series with a new AI or robotic exposure, or a personal review of outcomes and complications, and less on the front of reviews, pooled data from an institution.  

Research is surgery is equally important as much as the next field in medicine. For fellow young surgeons like me, articles are a source of knowledge from scratch – the background, the literature review, the discussion – it is a one stop shop for all queries and concerns I might have about a procedure, or implications of a procedure. But, everything in moderation is the key. Not each article is the best and there are many fallacies out on the vast web. In a world today where each article published is a glorious cap on the head, a crown of shine, and where everyone just wants to showcase their contributions, research has become yet another rat race. Sad, but true.

Good mentors, a keen eye for observation, a tremendous habit of reading, adaptability in biostatistics, never-give-up, try-till-you-make-it attitude and the firm withholding belief that one can manage a good surgical OR and a research cell makes a good researcher surgeon. Like all things are fair in surgery, love, and war, so does it apply to research too.

References

1. Kennedy GD. Overview: getting involved in research as a busy practicing surgeon. Clin Colon Rectal Surg. 2014 Jun;27(2):43-7. doi: 10.1055/s-0034-1376167. PMID: 25067916; PMCID: PMC4078210.
2. Jarry C, Valera L, Navarro F, Cerda J, Grasset E, Gabrielli M. Research in surgery: The adversities that every surgeon should know and face. Health Sciences Review. 2022 Mar 1;2:100016.

Images – google images