Many surgery residents spend dedicated research time in the middle of clinical training. From society grants to institutional fellowships, various programs aim to foster the next generation of academic surgeons. The attributes of the archetypical academic surgeon have been described as one who “(1) identifies complex clinical problems ignored or thought unsolvable by others, (2) becomes an expert, (3) innovates to advance treatment, (4) observes outcomes to further improve and innovate, (5) disseminates knowledge and expertise, (6) asks important questions to further improve care, and (7) trains the next generation of surgeons and scientists.”1 Academic surgeons have the potential to multiply their impact on patient lives by standing at the vanguard of surgical advances.

We share perspectives on how trainees in research time could realize their full potential to mature as academic surgeons who make meaningful contributions to surgical science (Table 1). We highlight 4 goals the trainees should consider—(1) defining the professional mission; (2) solidifying productive habits; (3) managing productive research teams, and (4) writing and presenting well—and how to overcome potential challenges.

TABLE 1 - Goals Trainees in Research Time Should Consider to Mature as Academic Surgeons Who Make Meaningful Contributions to Surgical Science Goal Challenge Recommendations Define the professional mission Undefined specialty and research interests Start on a trajectory based on present passion and ideas: acquire transferable skills Professional mission can evolve: re-assess mission and re-align efforts periodically Solidify productive habits Flexible, self-determined schedule (disorienting compared with structured clinical schedule) Minimize distractions (turn off email notifications, avoid task-switching, work through focus blocks) Focus on the 1 daily task where effort is needed most (avoid long checklists) Complete most important task when willpower is the strongest Learn speed reading Manage productive research teams Not feeling ready to manage teams Practice managing teams early Set clear, fair, consistent expectations (time commitment, author inclusion and order) Assemble team with complementary skill sets Organize data systematically (standardized taxonomy for file names and data extraction, include readable analytic code on manuscript submission) Work in parallel: large portions of manuscript can be completed before data analysis Use a reference management tool Sustain momentum (understand what motivates each member, set internal deadlines) Limit synchronous meetings to orientation and essential discussions Write and present well Limited prior structured education Writing Use a systematic template and repeat (read “Writing for Impact”) Follow reporting guidelines (eg, STROBE, PRISMA) Avoid common mistakes (read “Tips for authors of surgical manuscripts from senior reviewers”) Deliver message using fewest possible words Presenting Deliver one key message Type out presentation script to fine-tune succinct message Eliminate filler words and phrases (e.g. “my name is…”, “um”, “you know”) Methods: leave details on a Google doc that can be accessed via QR code 30:1 rule: practice 30 minutes for every 1 minute of presentation time

PRIMSA indicates preferred reporting items for systematic reviews and meta-analyses; STROBE, strengthening the reporting of observational studies in epidemiology.

DEFINE THE PROFESSIONAL MISSION

Surgical literature grows exponentially,2 yet unreliable and nonreplicable findings remain prevalent.3 Academic productivity is a byproduct of scientific inquiry but should not be the goal of research time.

Academic surgery’s scope may change: new disciplines (eg, health services research, biomedical informatics) and knowledge dissemination media (eg, online publications, social media) will emerge. However, academic surgery’s vision to improve patient lives through meaningful scientific inquiry is enduring. The best intersection of this vision and an individual’s talents and interests will define the professional mission. A clear professional mission —how to improve as many patient lives as possible through research— should guide priorities and efforts throughout research time.

A Potential Challenge

Identifying the professional mission may be challenging for the trainees whose specialty and research interests are undefined.

Our Suggestion

A professional mission can evolve. The present passion and ideas on how to improve patient lives should motivate acquiring skills for a starting trajectory. Many skills will be transferable regardless of one’s ultimate mission, and learning new skills itself can reshape the professional mission. Trainees should re-assess their professional mission and re-align efforts periodically.

SOLIDIFY PRODUCTIVE HABITS

Academic productivity comprises tangible outputs of scientific inquiry (eg, peer-reviewed publications and presentations). Productivity alone is insufficient to better patient lives and may not reflect the impact,4 but time dedicated to the scientific inquiry should yield tangible outputs.

A Potential Challenge

Transitioning from structured clinical schedules to a more flexible, self-determined schedule may be disorienting. Time-wasting habits are prevalent.

Our Suggestion

We highlight helpful habits that could facilitate staying focused and maximize productivity:5

Task-switching (eg, responding to email notifications) and multitasking have been estimated to cost up to 28% of an average workday. One study found that when working online, the median time before being distracted was 40 seconds.6 Checking email during set periods and working uninterrupted through set blocks (eg, 30 min) can mitigate wasting time. Checking off long checklists confounds activity for productivity. Complex projects can be broken into a series of key tasks. Defining the single most important task for the day, and prioritizing this 1 task, can direct effort where needed the most. Willpower is a limited resource. The most important task should be completed when willpower is the strongest (individual-dependent: ie, morning or evening, before or after meals). When willpower is low, addressing less intensive tasks or taking adequate breaks will optimize efficiency. The average adult reads ~200 words per minute. With practice, reading speed can double. A faster rate of absorbing information could liberate time for processing and creating knowledge. Solidifying habits requires discipline and can take up to 66 days,7 but productive habits will pay dividends. MANAGE PRODUCTIVE RESEARCH TEAMS

Research is a team sport. Productive academic surgeons are often great project managers who optimize team members’ time, skill sets, and collective momentum.

A Potential Challenge

Some trainees may hesitate to manage teams until they become faculty.

Our Suggestion

Team management is a distinct skill that should be refined early.

Set clear, fair, and consistent expectations to mitigate dysfunctional conflicts. Setting clear expectations (eg, time commitment, author inclusion, and order criteria) requires understanding the necessary data, analysis, and timeframe for project completion before recruiting team members. Author inclusion should follow the International Committee of Medical Journal Editors criteria, and the order should reflect project-specific contributions. Expectations should be consistent and communicated in writing with the team. For example, we expect the first authors to be responsible for idea conception, study design development, project management, large portion of data analysis, manuscript writing, submission, and revision. We designate co-first authors when 2 or more members contribute equally to project completion. Assemble a team with complementary skill sets. Together, team members should have all skill sets required to complete a project (eg, writing, statistical analysis). To avoid relying on 1 member’s commitment for project completion, critical technical steps (eg, complex statistical analyses) should be assigned to members with overlapping skill sets. Organize data systematically. Project folders should have structured subfolders (eg, “conference_abstract”, “data”, “analytic_code”, “manuscript”), and file names should follow standardized taxonomy. For example, we name files using dates (eg, “manuscript_jan_26_2022.doc”) and place old versions of files in an “old_files” subfolder. This taxonomy facilitates tracking up-to-date files, even when multiple authors revise different iterations. Standardized data dictionary should guide data extraction (eg, for institutional database reviews or systematic reviews). Standardizing how values are recorded (eg, “yes” rather than “Yes”, “1”, “present”, etc.) streamlines downstream data analysis. Transparency is essential for scientific integrity. Readable analytic code should be shared publicly upon manuscript submission (eg, hosted on GitHub repository). Organized data and readable code expedites addressing manuscript revision requests. While 1 team member is conducting data analysis, another member should be writing the introduction, methods, and parts of the discussion (eg, summary of existing literature). Large portions of manuscripts can be completed before the data analysis. With deliberate practice, managing multiple teams at different project cycle stages (eg, brainstorming, data analysis, writing, and revising) should be feasible. Use a reference management tool. References should not be managed manually. For example, using Zotero (available for free), team members can add references to a shared library, insert references on Microsoft Word or Google Docs, and format bibliographies that meet journal-specific requirements. Before the team orientation, we encourage meeting team members individually to understand what motivates each member and will keep them engaged in the project. Mutually setting milestones and keeping up with internal deadlines are essential to sustain momentum. Periods of unavailability (eg, exams, busy rotations) should be respected and considered when setting project timelines. Avoid nonessential meetings. Synchronous meetings (in person or online) should be reserved for team orientation and instances when live discussion is essential. Every meeting should have an agenda (ie,. team members should come prepared) and yield action items with mutually-set deadlines. WRITE AND PRESENT WELL

Good scientific communication is essential for disseminating knowledge. Writing and presenting well are 2 of the most important transferable skills to refine during research time.

A Potential Challenge

Few trainees may have received structured education on how to write and present well.

Our Suggestion

Writing and presenting can improve with systematic repetition and deliberate self-assessment.

Writing Well

Every manuscript should follow a systematic template (we follow Ibrahim and Dimick’s8 suggestions and study design-specific reporting guidelines (checklists compiled by the EQUATOR Network). The introduction should comprise 2 to 3 paragraphs that provide problem context, highlight knowledge gaps, and specify the hypothesis and aim.8 The methods and results should be delineated using the same subheadings (eg, study population, primary outcome) to direct readers’ attention. Detailed supplemental methods or publicly-shared analytic code (eg, hosted on GitHub) can keep the main text concise. The discussion should summarize key findings, put findings into the context of existing literature, highlight limitations, and suggest future research direction.8

Impactful writing is concise and simple. The fewest possible words should deliver a manuscript’s message. Most adjectives and adverbs are unnecessary. Re-phrasing and appropriate punctuation marks (eg, semi-colon, colon, brackets, em dash) can consolidate multiple sentences into 1. The active voice is more direct than the passive. Reading manuscripts out loud can highlight unpolished language and run-on sentences. Strunk and White’s “The Elements of Style” is an excellent guide on grammar and style.

We recommend reading “Tips for authors of surgical manuscripts from senior reviewers,”9 which highlights mistakes that prompt manuscript rejection decisions, and undergoing peer review training to refine self-assessment.

Presenting Well

A great presentation delivered in front of the appropriate audience can multiply a project’s impact. The typical conference audience listens to multiple sequential presentations, and attention may be scarce: delivering 1 key message is essential. Typing out the presentation script (even if not referenced during the presentation) facilitates fine-tuning a succinct message within the time limit. A common filler to eliminate is “My name is … and I am…”; the presenter’s name is displayed on the title slide and often announced by the moderator. Eliminating filler words (eg,. “um”, “you know”) requires deliberate practice.

Detailed methodology is challenging to follow. We suggest describing an overview and displaying a QR code that directs the interested audience to detailed written methodology posted on a Google doc. Rather than a “thank you” or “questions?” slide, we suggest concluding with a “takeaway” slide that summarizes the key message and contact information to facilitate follow-up.

A presentation is a public reflection of the research team, department, and institution.10 Recording and reviewing practice presentations to refine both speech and body language is essential. There is no substitute for practice: we recommend a “30:1 rule”—practicing 30 minutes for every minute of presentation time.

Deliberate self-development can maximize growth during research time. We hope our perspectives provide actionable guidance for those embarking on a life meaningfully spent as academic surgeons.

ACKNOWLEDGMENTS

Dr Choi thanks Dr. Joseph D. Forrester (Stanford University) for his mentorship and dedication to professional growth throughout research time, Dr Andrew M. Ibrahim (University of Michigan) for inspirations on how to communicate well, and Dr Thomas M. Krummel (Stanford University) for lessons on how to present better.

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