The Sinatra Doctrine: bespoke approaches to academic research in surgery

Abstract

Introduction Academic scholarly credentials are now obtained in two broad ways: out of programme research (OOPR) experience via bespoke funding (BF) or a higher degree (HD) funded by run-through fellowships (academic clinical fellow/lecturer in England or Wales Clinical Academic Track [WCAT]). The aim of this study was to determine the relative academic credentials achieved related to HD route, surgical specialty and topic. Methods Fifty-four postgraduate trainees engaged in HD study were followed and the primary outcome measures were HD completion, publication number and Hirsch index (HI). Results There were 38 BF trainees and 16 WCAT trainees. General surgical trainees were more likely to choose postgraduate research (n = 37, 68.5%) than other specialties (n = 17, 31.5%). Similarly, trainees in general surgery were more likely to choose the BF route than the WCAT pathway (94.6% vs 12.5%, (p < 0.001), with ethnic minorities also more likely to choose WCAT (56.3% vs 18.4%, p = 0.005). HD completion rates were 82.1% in the BF cohort and 88.9% in the WCAT group (p = 0.409). The median number of publications was 17 versus 18 respectively (p = 0.894) and the median HI was 7 in both groups (p = 0.690). OOPR experience during phase 1 of surgical training was associated with a higher HI (11 vs 0, p = 0.011). Degree type (MD vs PhD) was not associated with HD completion (80.0% vs 91.7%, p = 0.374), publication number (15 vs 19, p = 0.958) or HI (7 vs 5, p = 0.107). Conclusions HD routes appear equivalent although specialty related HI outcomes varied over fourfold. Trainees and training programme directors alike should be aware of these outcomes when planning OOPR training. Surgical training is multifaceted and should result in a competent clinician, able scholar, first class communicator, health advocate and well rounded professional. 1 Surgical research has served as the foundation for evidence-based clinical practice as long ago as Galen. 2 Nevertheless, in the UK and since the inception of Modernising Medical Careers, out of programme research (OOPR) experience has lost its allure. 3 , 4 Indeed, other distinguishing credentials are available, such as subspecialty clinical attachments, and qualifications in management, education and leadership.