Surgical education research seeks to understand the factors that affect surgical training. Recent challenges to longstanding training paradigms have created a pressing need to improve our approach to surgical education. Surgical educators need to efficiently train surgeons to perform increasingly complex procedures in a manner that optimizes both patient safety and resource utilization while meeting expanding regulations related to work hours; much of surgical education research is directed specifically at developing and validating methods to accomplish this goal. Examples of surgical education research include comparing the effectiveness of com- puter-aided simulation vs. animal lab training for teaching advanced laparoscopic procedures, evaluating the effects of teaching techniques on trainee retention of lecture material, and determining whether medical students with the best technical skills choose careers in surgical specialties.

Going Forward

In summary, choosing a career in academic surgery enables one to provide state-of-the-art clinical care, discover and apply new knowledge to surgical problems, teach trainees and surgeons throughout the world, and inspire others toward ever greater achievements. Each type of surgical research - basic science, translational, clinical, outcomes, and educationenables surgeon-scientists to advance the field and amplify their impact on patients' lives.

Having addressed the "What" and the "Why," the remainder of this book will focus on how to become a successful academic surgeon. As you move forward, I encourage you to periodically reflect on what your impact factor will be and to keep in mind one simple message: There is no career more rewarding than that of an academic surgeon.

Acknowledgments The author wishes to thank Stephen N. Palmer,

PhD, ELS, for editorial assistance and Scott A. Weldon, MA, CMI, for assistance with the illustrations.

10 S.A. LeMaire

Selected Readings

Chiu RC. The challenge of "tending the bridge". Ann Thorac Surg.

2008;85:1149-1150.

Cosimi AB. Surgeons and the Nobel Prize. Arch Surg. 2006;141:

340-348.

Hill GL. Surgeon Scientist: Adventures in Surgical Research. Auckland:

Random House; 2006.

Moore FD. A Miracle and a Privilege: Recounting a Half Century of Surgical Advance. Washington, D.C.: Joseph Henry Press; 1995.

Murphy AM, Cameron DE. The Blalock-Taussig-Thomas collaboration: a model for medical progres& lAMA. 2008;300:328-330.

FIGURE 2.1 Overall promotion timeline

comes with the use of your professional title on your CV, your business cards, and in other business interactions within the medical field. Promotion, by way of advancement of this professional title from instructor to assistant professor, to associate professor, and eventually to full professor, then serves as the gauge of progress along the time continuum that makes up one’s academic surgical career (Fig. 2.1).

Seen in that light, promotion is therefore a critically important concept, yet one for which there is generally no formal teaching and one that is arguably poorly conveyed through your formative years of medical school and residency. How, therefore, are we supposed to navigate the process without any guidance or experience? This chapter is designed to get you started, to provide the basic concepts and a basic framework. It comes less from textbooks or the literature, but largely from the author’s experiences and those of his peers’ through lectures delivered at the Association for Academic Surgery’s Fundamentals of Surgical Research and Career Development Courses. However, at the end you will find a brief bibliography that will direct you to additional material on the subject.

Preparation Phase

If you look at Fig. 2.2, it spans roughly a 20-year period over which you need to acquire the credentials upon which you will be judged for promotion. So this takes foresight and preemptive planning, even well before your first faculty appointment. Many of the readers may already be in their first academic job, and as such, may have missed the opportunity to orchestrate this planning phase, but I am guessing many of

Undergraduate/Medical School research Fellowships

T32 or other research fellowships in residency

Masters or other advanced degree work as junior faculty

Development of research program and preliminary data

Submission of intramural or foundation grants

Submission of career development (i.e., “K”) award

Conduct of K-award Grant

Submission of independent investigator (i.e., R01) grant

FIGURE 2.2 Detailed timeline to first promotion

you accomplished this phase, either consciously or subconsciously, to get to your current position.

The process really begins in undergraduate school, or at the very least,in the preclinical years of medical school.Somewhere along the line you must have been exposed to research to a sufficient degree that this experience, or perhaps an individual person with whom you worked, influenced your decision to pursue an academic career in medicine. You may have done research as a summer National Research Service Award (NRSA) scholar as an undergraduate, or you may have decided to go on to graduate school to pursue a full PhD. Others may have decided to pursue a combined MD-PhD degree, while still others may have just done research along the way in an advanced scholar’s track that promoted research and academics. Whichever path you took, it is here that you first learned the importance of a good research idea or question, were introduced to the scientific method used to investigate and analyze that question, and perhaps were even given the opportunity to present and publish your findings. These concepts and experiences provide the critical tools upon which to build your initial academic skill set.

The next step in this preparation phase is the selection of an academic residency program in which to train.

14 P.R. Nelson

TABLE 2.1 Select NIH program offerings that support resident academic training

Adapted from National Institutes of Health. http://grants.nih.gov/grants/ guide/parent_announcements.htm

You need to seek out a program that will not only train you well clinically, but one that maintains a strong commitment to academics and provides resources for residents to spend dedicated time doing research. Research fellowships offered by the National Institutes of Health (NIH) (i.e., T32 training grants) generally supply a resident with 2 years of salary and research funding and are one of the best support mechanisms for this activity (Table 2.1).Traditionally,funding was intended for residents in a basic science lab of a surgical mentor doing conventional bench-top research, but more recently, training programs and opportunities have expanded to include similar support for translational research, clinical research, health sciences (outcomes) research, and/or education-based research. Other institution-based NIH-training programs are often available for these additional pursuits such as a K30program that provides tuition for additional coursework or a