A graduating surgical resident is an expert clinician and scientist. The Accreditation Council of Graduate Medical Education (ACGME) endorses the surgeon-scientist in its requirement for scholarly activity, emphasizing a “scholarly approach to patient care…grounded in the principles of evidence based medicine...[and expanding] the knowledge base through dissemination.”1,p35 This dissemination occurs through publication in peer-reviewed forums, and bibliometric profiling with citation metrics, such as the Hirsch index (h-index), measures an individual’s research output.2 Academic rank is correlated with h-index,3,4 and gender disparities exist in publication productivity among surgery faculty.5,6 This study aimed to characterize the publication productivity of graduating general surgery residents and to assess factors associated with a chief resident’s academic research output.
For this cross-sectional study, the names of residents graduating in 2020 from general surgery programs listed by the Electronic Residency Application Service were gathered from program websites. An author search for the number of publications and h-index for each resident in Scopus, and all publications were included irrespective of year published. This study was approved by the Regional Health Command-Pacific Institutional Review Board. Informed consent was waived because the research involved no more than minimal risk to the individuals included in the analysis. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
A negative binomial regression model was used to evaluate the associations of sex, program academic status (as defined by the American Medical Association Residency and Fellowship Database), region (as defined by the US Census Bureau), graduating class size, mandatory research time, and program-level American Board of Surgery Qualifying Exam and Certifying Exam (CE) 5-year first-time pass rates with a resident’s number of publications and h-index. A logistic regression model was generated to compare individuals who did and did not have at least 1 published research article. K-means clustering was attempted but did not reveal any useful results. Statistical analyses were performed using R, version 3.6.1 (R Project for Statistical Computing). A 2-sided P < .05 was considered statistically significant.
From 225 Electronic Residency Application Service–listed programs, 1086 graduating residents were identified (699 [64.4%] male). In this study cohort, the median number of publications was 3 (interquartile range, 0-7) and the median h-index was 1 (interquartile range, 0-3). A total of 780 residents (72%) had at least 1 publication. Negative binomial regression revealed that residents in the West, at university programs, and with mandatory research time had more publications (South vs West: incidence ratio [IR], 0.56 [P = .001]; Northeast vs West: IR, 0.68 [P = .05]; Midwest vs West: IR, 0.70 [P < .05]; university vs community program: IR, 3.76 [P < .001]; mandatory research time: IR, 1.93 [P < .001]). Residents at university programs and with mandatory research time had a higher h-index (university vs community program: IR, 2.73; mandatory research time: IR, 1.96; P < .001 for both). Logistic regression revealed that compared with residents in the West, residents in other regions had a lower likelihood of having published research (Midwest, 50.9% [95% CI, 27.2%-92.7%; P = .03]; Northeast, 47.7% [95% CI, 24.5%-90.6%; P = .03]; and South, 36.8% [95% CI, 20.1%-65.1%; P < .001]). Residents attending university programs were more likely to have published research than were those attending community and community or university programs (odds ratio, 2.57; 95% CI, 1.48-4.43; P < .001). Residents attending programs with mandatory research time were more likely to have published research (OR, 2.42; 95% CI, 1.33-4.81; P = .006). There was no significant difference between males and females in median number of publications (3 vs 3; P = .14) or h-index (1 vs 1; P = .17), and sex was not associated with more publications (IR, 0.96; P = .70) or a higher h-index (IR, 1.01; P = .86)
This cross-sectional study of residents graduating in 2020 from general surgery programs found that most residents had published at least some research during training. Factors associated with productivity and research output included attending a program in the West, attending a program with a university designation, and having mandatory research time. In contrast to studies evaluating surgical faculty,6 in the present study, there was no difference in resident productivity by sex. This study is limited by the cross-sectional nature, only reflecting a single year of graduating residents, and by the use of only publicly available information excluding chief residents without names listed publicly on program websites. Further research is needed to characterize publication trends over time among programs and individuals and to identify factors contributing to disparities.
Accepted for Publication: April 3, 2021.
Published Online: June 9, 2021. doi:10.1001/jamasurg.2021.2073
Corresponding Author: Torbjorg Holtestaul, MD, Madigan Army Medical Center, Joint Base Lewis-McChord, 9040A Jackson Ave, Tacoma, WA 98431 (firstname.lastname@example.org).
Author Contributions: Dr Holtestaul had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Holtestaul, Jones, Nelson, Vreeland, Bingham, Yheulon.
Acquisition, analysis, or interpretation of data: Holtestaul, Jones, Colburn, Bingham.
Drafting of the manuscript: Holtestaul.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Holtestaul, Jones, Colburn, Nelson, Bingham.
Administrative, technical, or material support: Holtestaul, Yheulon.
Supervision: Nelson, Vreeland, Bingham, Yheulon.
Conflict of Interest Disclosures: None reported.
Additional Contributions: Spencer Brewer, BS (Madigan Army Medical Center), helped with data collection and background research and was not compensated.
MD. The h-index outperforms other bibliometrics in the assessment of research performance in general surgery: a province-wide study. Surgery
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