Flourish or perish: The UK academic surgeon model

Abstract

Progress in cardiac surgery will continue to be driven by surgeons who are willing to dedicate their time to answering pertinent research questions in their field. If we reflect on the great discoveries that made open-heart surgery possible, the heart-lung machine, or development of myocardial protection, for example, these would not have been possible without an inquisitive mind and significant time spent in the research laboratory. 1,2 Although surgeons must dedicate a significant amount of their time and stamina to clinical work, they are in a unique position to identify clinical problems, understand their mechanisms of action using basic science, and take possible solutions back into everyday clinical practice.However, succeeding in this dual role of "surgical investigator" is no easy undertaking, and you need to have the drive, discipline, and focus. It is less arduous to go and do an operation than to develop research ideas, write a grant, publish a paper, or be responsible for the mentoring and the supervision of your research group. Despite these challenges, working with a diverse multidisciplinary research team to improve patient care, the opportunity to travel around the world to present the ideas that are generated, networking, and being a voice at the forefront of the research in your field are unparalleled satisfactions of being an academic surgeon.We have read with great interest the work by Ikonomidis and colleagues 3,4 and Lawton 5 in this Journal. They discuss the challenges and the solutions to prevent the extinction of the surgeon-scientists in the United States. We herein continue to share our thoughts about the UK model of the academic surgeon in general. How do we produce academic surgeons? Who and how we should run surgical research? What are the research topics on which we should focus? AMATEUR OR PROFESSIONAL?In a commentary in the Lancet in the 1990s, Horton 6 described surgical research as "a comic opera," highlighting that only 7% of the articles in surgical journals reported data from randomized trials in the United Kingdom. During that time, the British Heart Foundation (BHF) was the leading charity providing funds for cardiovascular research, whereas the Medical Research Council (MRC) and the Wellcome Trust (WT) were funding a much broader portfolio. There were 4 BHF professorial chairs in cardiac surgery in the United Kingdom and little incentive to embark on a research career, not the least because of the great demand for private practice. The waiting list for an elective cardiac surgery procedure in the National Health Care System (NHS) was up to 12 to 16 months.Research in cardiac surgery has certainly evolved to the extent that we now have dedicated, university academic cardiac surgeons leading successful units, but also honorary NHS academics actively engaging in research. Highquality research outputs come from the combination of

Is it time for integrated academic pathways in SET training?

“…The integrated Clinical Academic Fellowship pathways for surgical training in the United Kingdom (UK) are well established and have been demonstrated to improve both research output and clinical skill development. 6,7 Research pathways integrated into residency training in the United States resulted in participants scoring higher on national board examinations, improved research productivity and sustained academic success. 8,9 UK ENT trainees who undertook LTFT in dedicated integrated research programs achieved more publications and academic output than nonintegrated trainees in both full-time and part-time clinical positions.…”

“…Experiences from international training programs provide insights into how we can address this challenge. The integrated Clinical Academic Fellowship pathways for surgical training in the United Kingdom (UK) are well established and have been demonstrated to improve both research output and clinical skill development 6,7 . Research pathways integrated into residency training in the United States resulted in participants scoring higher on national board examinations, improved research productivity and sustained academic success 8,9 .…”

Commentary: Different location, same challenges

“…I read with interest the excellent review in this issue of the Journal by Fudulu and Angelini 1 regarding the academic surgeon model in the United Kingdom. This carefully constructed review succinctly laid out the status of academic cardiac surgery primarily from the clinical research perspective and summarized the important obstacles that UK surgeons must tackle to have successful clinical and research careers.…”