Academic surgery: Challenges and opportunities

The combination of excellence in research and clinical care is crucial to the advancement of surgery. Many significant innovations in surgery have emerged from clinicians striving to improve patient care. ¹ However, academic surgery is currently under siege. The three pillars of academic surgery—clinical care, education, and research—have become increasingly difficult to balance. ² The growing demands for medical excellence and increased workload have significantly limited the ability to combine research with medical care. In addition, the demands for research quality and the complexity of methodologies have evolved. Moreover, the career path that combines clinical care and research has become less attractive and more uncertain in a world with shifting priorities toward work–life balance. ³ Consequently, many physicians opt for private institutions with well-paid positions.

Data indicate that clinical practice at the junior faculty level severely hinders the ability to conduct research. Leadership in surgical departments must protect their junior faculty from administrative and clinical duties to promote academic achievement. ⁴ Several authors emphasize the crucial role of mentorship and the mentor–mentee relationship in achieving success in medical research. ⁵ A systematic review of mentorship highlights the need for commitment, interpersonal skills, and a supportive environment. ⁶

Early recruitment of medical students into academic surgery is one strategy to revitalize the field. Several academic departments have established programs to attract bright, young individuals early in their medical education. We need to attract “la crème de la crème” to academic surgery to reverse the current negative trend.

How the new generation of medical students will affect recruitment to academic surgery remains to be seen in the coming years. The evolving demands of family life are also changing the possibilities for both genders to work in academic surgery. To succeed in academic surgery, having a role model is essential. This role model should be able to balance all three aspects of academic surgery. If department chairs promote research, supervisors and their PhD students will receive important feedback to continue their scientific pursuits.

An important aspect of academic surgery is to treat different surgeons according to their specialties. For instance, if someone is a dedicated hepatobiliary surgeon, the chair of the surgical department should enable this person to focus primarily on the clinical area related to their research. While some may argue that this is an elitist perspective, without such focus, achieving significant progress is unlikely. Focusing early on a clinical area combined with research within the same field will accelerate the process of internationalization and the creation of a network of colleagues, which is fundamental to success in the modern academic world. Supervisors should encourage their PhD students to spend 1–2 years outside their home department to gain new knowledge and develop important personal contacts for the future.

With the common trunk approach in surgical education, surgical residents will gain experience from both secondary and tertiary surgical departments. To achieve the trinity of clinical care, education, and research, the education of the surgical residents must be well-structured. This modern form of education will allow surgical residents to progress in both surgical skills and research.

The main supervisor for an active surgeon should be another surgeon to ensure the connection between research and clinical problems. However, a co-supervisor from a pre-clinical or technical research area might improve the depth of the research and should be encouraged. Within a department, different supervisors should collaborate to create an infrastructure for their PhD students. Weekly meetings should be held where PhD students can present their research. Supervisors should also encourage PhD students to engage in the education of junior doctors and medical students. Explaining complex concepts to someone without in-depth knowledge requires a true understanding of the field.

To stop the downward spiral in academic surgery, far-reaching changes are needed. Academic centers should consider requiring formal academic training, such as a doctoral degree or a graduate degree in basic or clinical research methodology, for attaining a consultant position. This requirement would encourage research and compel departments to promote research, providing the necessary time and funding to ensure future academic surgeons. Finally, a thorough change in the culture of many surgical departments is needed to reinvigorate academic surgery and ensure a scientific approach to surgery in the future.