What does it take to be A successful pediatric surgeon-scientist?

Carey Watson; Alice King; Shaheel Mitra; Aimen F. Shaaban; Allan M. Goldstein; Michael J. Morowitz; Brad W. Warner; Timothy M. Crombleholme; Sundeep G. Keswani

doi:10.1016/j.jpedsurg.2015.03.037

What does it take to be A successful pediatric surgeon-scientist?

Carey Watson, Alice King, Shaheel Mitra, Aimen F. Shaaban, Allan M. Goldstein, Michael J. Morowitz, Brad W. Warner, Timothy M. Crombleholme, Sundeep G. Keswani

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

Background: The factors that contribute to success as a pediatric surgeon-scientist are not well defined. The purpose of this study is to define a group of NIH-funded pediatric surgeons, assess their academic productivity, and elucidate factors that have contributed to their success. Methods: Pediatric surgeons were queried in the NIH report database to determine NIH funding awarded. Academic productivity was then assessed. An online survey was then targeted to NIH-funded pediatric surgeons. Results: Since 1988, 83 pediatric surgeon-investigators have received major NIH funding. Currently, there are 37 pediatric surgeons with 43 NIH-sponsored awards. The mean h-index of this group of pediatric surgeons was 18 ± 1.1, mean number of publications (since 2001) was 21 ± 2.1, and both increase commensurate with academic rank. In response to the survey, 81% engaged in research during their surgical residency, and 48% were mentored by a pediatric surgeon-scientist. More than 60% of respondents had significant protected time and financial support. Factors felt to be most significant for academic success included mentorship, perseverance, and protected time. Conclusions: Mentorship, perseverance, institutional commitment to protected research time, and financial support are considered to be important to facilitate the successes of pediatric surgeon-scientists. These results will be useful to aspiring pediatric surgeon-scientists and departments wishing to develop a robust research program.

Original language	English
Pages (from-to)	1049-1052
Number of pages	4
Journal	Journal of Pediatric Surgery
Volume	50
Issue number	6
DOIs	https://doi.org/10.1016/j.jpedsurg.2015.03.037
State	Published - Jun 1 2015

Keywords

NIH
Pediatric surgery
Success
Surgeon-scientist
h-index

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10.1016/j.jpedsurg.2015.03.037

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@article{ef2283a0addc45738ab67e17838bb07f,

title = "What does it take to be A successful pediatric surgeon-scientist?",

abstract = "Background: The factors that contribute to success as a pediatric surgeon-scientist are not well defined. The purpose of this study is to define a group of NIH-funded pediatric surgeons, assess their academic productivity, and elucidate factors that have contributed to their success. Methods: Pediatric surgeons were queried in the NIH report database to determine NIH funding awarded. Academic productivity was then assessed. An online survey was then targeted to NIH-funded pediatric surgeons. Results: Since 1988, 83 pediatric surgeon-investigators have received major NIH funding. Currently, there are 37 pediatric surgeons with 43 NIH-sponsored awards. The mean h-index of this group of pediatric surgeons was 18 ± 1.1, mean number of publications (since 2001) was 21 ± 2.1, and both increase commensurate with academic rank. In response to the survey, 81% engaged in research during their surgical residency, and 48% were mentored by a pediatric surgeon-scientist. More than 60% of respondents had significant protected time and financial support. Factors felt to be most significant for academic success included mentorship, perseverance, and protected time. Conclusions: Mentorship, perseverance, institutional commitment to protected research time, and financial support are considered to be important to facilitate the successes of pediatric surgeon-scientists. These results will be useful to aspiring pediatric surgeon-scientists and departments wishing to develop a robust research program.",

keywords = "NIH, Pediatric surgery, Success, Surgeon-scientist, h-index",

author = "Carey Watson and Alice King and Shaheel Mitra and Shaaban, {Aimen F.} and Goldstein, {Allan M.} and Morowitz, {Michael J.} and Warner, {Brad W.} and Crombleholme, {Timothy M.} and Keswani, {Sundeep G.}",

note = "Funding Information: During the time period of 1988–2012, 105 pediatric surgeons (16% of APSA members in 2012) received funding through the NIH through various mechanisms. Eighty-three (13% of APSA members) of these surgeon–scientists have received major funding other than an F32 grant (National Research Service Award). There were 37 pediatric surgeons with current funding claiming 43 NIH-sponsored awards, including 17 R01 and 9 K08 awards. Twenty-one percent of investigators used the K08 award mechanism to transition to independent investigator status (R/U grants). For the year 2012, pediatric surgeon–scientists received a total of $7.2 million dollars from various NIH institutes and centers. To assess academic productivity of this group of funded pediatric surgeons (n = 105), we utilized the PubMed database, which revealed a total of 2214 publications listed during the 10-year period from 2002 to 2012. These publications were in a wide variety of both basic science and clinical journals. However, the 5 most common journals where this cohort of surgeons published were the following: Journal of Pediatric Surgery (32.1%), Fetal Diagnosis & Therapy (5.8%), Pediatrics (3.8%), Obstetrics & Gynecology (2.8%), and Annals/Archives of Surgery (1.6%) ( ). The mean number of publications per pediatric surgeon–scientist in this 10-year period was 21 ± 2.1. Additionally, using the SCOPUS database, we were able to derive the ± 1.1. Additional internet database searches were used to find the academic rank for each individual surgeon–scientist. Both number of publication and ). Fig. 1 h -index for each individual surgeon–scientist. The mean h -index in this study was 18 h -index commensurately increase with academic rank ( Fig. 2 We then designed an online survey to elucidate the perceptions of these funded scientists about their research path and what factors they believed contributed to their success. The response rate for the survey was 40% (42 of 105). We divided the survey into three parts, (1) demographics and research experience as a trainee, (2) characteristics of the first faculty position and (3) factors that contribute to scientific success. Demographics and research experience as a trainee. One hundred percent of the respondents had an MD (or equivalent) degree and 20 (48%) had an additional degree including PhD, MBA, or MS. Ten (50%) of those with an additional degree felt that the extra degree was helpful in their pursuit of an academic career. Sixteen (38%) had at least 1 year of research experience prior to their general surgery residency and 31 (74%) completed at least 6 months of research between the start of general surgery residency and starting a pediatric surgery fellowship. We then inquired about mentorship during their training period and their perception about pursuing a research-oriented career. Thirty-three (79%) had a surgeon–scientist as a research mentor and 20 (48%) specifically had a pediatric surgeon–scientist. Twenty-three (55%) had a focus in basic science, whereas 16 (38%) had a focus in both basic and clinical science. Twenty-five (60%) either intended or strongly intended to pursue a research-oriented career at the start of their general surgery residency. This number substantially increased for those that intended or strongly intended to pursue a research-oriented career by the time they started their pediatric surgery fellowship to 38 (90%). Characteristics of the first faculty position. After fellowship in their first faculty position, 33 (79%) had a position which included a research component. Twenty-seven (64%) also initially had protected time for research as a new attending. In their first attending position, 22 (52%) had a field of study similar to that of their research prior to their pediatric surgery fellowship, whereas 28 (67%) have current NIH funding in a different field. Twenty-five (60%) joined the lab of an established investigator in their first research environment. Although most (67%) of these first faculty positions were at institutions different from where they did their research as trainee, 12 (29%) of the respondents returned to the same institution or lab of their research mentor. Thirty-two (76%) joined a practice with other surgeon–scientists and 35 (83%) have colleagues within their department also pursuing extramural funding. Only 12 (29%) are at an institution that gives financial incentives for academic and research productivity. Twenty-five (60%) of the institutions provided financial support for a lab technician and 26 (62%) provided financial support for laboratory supplies. Only 5 (12%) had no help or support from their institution ( ). Fig. 3 Factors that contribute to scientific success. We then asked an open-ended question to identify specific factors that individual investigators attributed most to their success as a funded investigator. Answers could be divided into common themes. The 4 most common themes were mentorship (38%), persistence/perseverance (29%), protected time (19%), and hard work (12%). 3 Funding Information: Our study population consisted of all current members of the American Pediatric Surgical Association (APSA) as listed in the directory in July of 2012. The NIH Research Portfolio Online Reporting Tools (RePORT) database was then used to query this list of pediatric surgeons in order to obtain NIH funding information for all surgeons receiving a grant during the period of 1988 to 2012. The NIH RePORT is an online database provided by the NIH with reports, data, and analysis of NIH research activities with data available starting in 1988. We then assessed academic productivity of this cohort of pediatric surgeons by determining academic rank and using publication history and h- index as a surrogate for academic progress. Publication history was determined using a query of PubMED and SCOPUS databases (for previous 10-year period from 2002 to 2012), h -index, and academic rank. The h -index or Hirsch index is an index that attempts to measure both productivity and impact of the published work of a scientist. A scientist has an index h if h of his/her N p papers have at least h citations each, and the other (N p − h) papers have no more than h citations each. Therefore, a scientist with an h -index of h has published h papers each of which has been cited in other papers at least h times. The index is meant to help quantify the cumulative impact and relevance of an individual{\textquoteright}s scientific research output [2] . Academic rank for each individual surgeon was grouped into assistant professor, associate professor, professor, and chairman/surgeon in chief. To elucidate factors that this group of NIH funded surgeons believed was important to their success; we used an APSA-approved online survey to target this cohort of NIH-funded surgeons. The survey was approved by the institutional review board (IRB study ID: 2012-1949). The survey consisted of 28 questions related to training, prior research experience, current research experience, and additional factors felt to be major contributing factors to their success. The data are presented as mean ± SEM. 2 Funding Information: To our knowledge, this is the first paper to identify a cohort of pediatric surgeons that have obtained NIH funding, examine their academic productivity, and delineate factors that have contributed to their scientific success. Overall 13% of the current APSA membership has had major funding from the NIH. This may seem like a relatively low number, but it favorably compares to other surgical subspecialties [6] . As one might expect, our analysis shows that this group of surgeons has a strong publication track record and a relatively high h -index score, which supports not only the volume of scientific productivity but also the impact of the work produced. The h -index is a useful tool that is gaining wider acceptance. It was originally described by Jorge Hirsch to provide a metric to gauge scientific impact. It addresses some of the issues of using a journal{\textquoteright}s impact factor alone to judge a manuscript and more relies on the actual article{\textquoteright}s own citation merit. Hirsch followed up his original description with a comparison of the h- index to other academic metrics such as citation count, citations per paper, and total paper count and demonstrated that the h -index was superior in predicting future scientific achievement [7] . Ideally the h -index evaluates both quantity and quality of academic productivity. However, there are some potential downsides to using the h -index. These include fostering a tendency to evaluate people by 1 overly simplified metric rather than the whole person, tending to increase with age even though productivity may have ended, it is likely widely variable by the field of study and there may be some inherent biases on the way it is calculated. We then used a survey to define some of the characteristics of this NIH-funded pediatric surgeon–scientist population. Interestingly, 60% of respondents knew at a very early stage that they intended to pursue a research-oriented career. However, even more impressive is that 90% had this same intention before starting their fellowship. This perception at such an early career stage is likely in part because of an interaction with a pediatric surgeon–scientist and speaks to the importance of current pediatric surgeon–scientists continuing to have a positive influence on our current generation of surgical trainees. Furthermore, the survey demonstrated a wide spectrum of first faculty positions, but most sought out positions with established mentors, protected time, and financial departmental support, likely the 3 key elements to success in achieving an impactful scientific career. This is supported by the responses of funded investigators for the most important factors that have contributed to their scientific success, including mentorship, persistence/perseverance, protected time, and hard work. Our survey did elucidate some of the factors that were characteristic of successful surgeon–scientists. One can also infer some of the negative factors that may lead to failure, for example; poor mentorship and lack of departmental support both in terms of financial support and protected time. However, an argument can be made that the foremost barrier to achieving NIH funding is the NIH itself. The NIH budget has remained stagnant for the better part of a decade with more than a billion dollars cut in the last 3 years [8] . This restrictive funding environment coupled with the ever-growing demand for surgeons to be more clinically productive and generate more RVUs represents a truly challenging obstacle to overcome. Francis Collins, the director of the NIH, made the comment in the light of a 25% reduction of its purchasing power over the last decade that {"}many young investigators are on the brink of giving up because of the difficulty of getting support.{"} [9] . This unfortunate state of affairs has already taken its toll on surgeons applying for NIH funding. Studies have shown that surgical grant proposals to the NIH are less likely to be funded and often come with a smaller award as compared to non-surgical subspecialties. Additionally, surgeons make up a relatively smaller portion of study section members for the NIH peer-review process [5] . Surgeon–scientists were also found to be less successful when applying for major career development awards (K-awards) designed for clinical scientists when compared with non-surgical departments. Furthermore, surgeon–scientists were less likely to apply for these career development awards when compared with non-surgeon scientists [10] . Taken together, it makes the 13% success rate of pediatric surgeons in obtaining NIH funding all the more impressive. There are some significant advantages in the design of this study but also some limitations. The most significant design advantage of this study is the focus on the subspecialty of pediatric surgery itself. Pediatric surgeons are a relatively smaller population compared to other specialists such as cardiothoracic, colorectal or plastic surgeons. In addition, most pediatric surgeons and almost all academic pediatric surgeons are members of APSA and therefore, there is only a small possibility that a funded pediatric surgeon was accidently excluded in the data collection. However, pediatric surgery is also a limitation in extrapolating the results of this study because there is an inherent bias in that the population of surgical trainees that choose a career in pediatric surgery may already be pre-determined to pursue a research-focused career as evidenced by the 60% of survey respondents who held that belief prior to starting their research as a trainee. Another limitation is that in assessing the academic productivity we chose a 10-year time interval to examine. Younger surgeons are at a disadvantage because they have been in practice for less of the 10-year period than more senior surgeons. Additionally, one other major limitation in extrapolating these data is that we chose to use the funding from the NIH as the gold standard for research success. There are other federal and non-government funding sources that also represent a benchmark of academic success, but obtaining that complete data set would be very challenging and prone to being inaccurate and incomplete; therefore we opted to only use NIH funding sources. Another minor limitation of this study is that these data rely on databases, although both the PubMed and NIH RePORT are government maintained and considered reliable sources. Additionally, we had a 40% response rate for the survey, so there may be some selection bias introduced. In summary, we have identified a population of surgeon scientists that have been awarded funds from the NIH and developed impactful scientific careers, despite the inherent challenges and obstacles to doing so. This study has elucidated some of the pathways and experiences that these researchers have taken from training to first faculty position in order to identify common themes in achieving success. This information will be useful to surgeon–scientists across a variety of subspecialties as well as academic institutions encouraging research endeavors amongst faculty. This information will also undoubtedly be useful to those interested in pursuing an academic research career as well as those interested in or applying to the field of pediatric surgery, who will continue the tradition of success as pediatric surgeon–scientists in the future. Publisher Copyright: {\textcopyright} 2015 Elsevier Inc. All rights reserved.",

year = "2015",

month = jun,

day = "1",

doi = "10.1016/j.jpedsurg.2015.03.037",

language = "English",

volume = "50",

pages = "1049--1052",

journal = "Journal of Pediatric Surgery",