Residents should not be mandated to do research

In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or who spent a year in someone’s lab really learns anything about research or how to read and understand a research paper.

Nothing has changed.

According to the ACGME Program Requirements for Graduate Medical Education in General Surgery Section II.B.5.e: Clinical and/or basic science research must be ongoing in the residency program; based at the institution where residents spend the majority of their clinical time; and performed by faculty with frequent, direct resident involvement.

Recently, the Journal of the American College of Radiology published a Point/Counterpoint on the value of resident research. Two academic radiologists took the “point” position that required research in radiology residency programs should be eliminated.

To support their position, they cited the following:

Only 23 percent of practicing radiologists work in academia.
Even a full year of research is not enough time to investigate a subject and have it presented or published.
Many other topics such as health care economics, global health, and dealing with independent practice should be taught in lieu of research.
Resident research is usually of low quality and the time spent is “of limited utility to most residents entering practice.”

As a former chief of surgery and director of a small community hospital residency program, I agree with the authors’ statement, “Among the myriad struggles inherent to smaller programs is a relative lack of scientific pedigree, hospital research coordinators, and statistical support staff members enjoyed by programs sponsored by research-intensive universities.”

I would add that most faculties in small programs do not have the time, the desire, or the ability to do research.

My favorite quote from the paper is, “Under the current paradigm of radiology GME, programs fritter away trainees’ valuable time on mandatory research projects, then send them out into the real world as sheep among wolves, unprepared for the harsh reality of clinical practice.”

The authors point out that because of the “exponential rise in mandatory ACGME requirements,” the curriculum for residency education is a zero-sum game. In other words, there’s only so much time for resident education, and the time should be spent more wisely.

A radiologist from Boston University took the counterpoint that research by radiology residents is meaningful and important. To support his argument, he referenced a paper that stated “an analysis of factors influencing radiologists’ career decisions found that those who published in residency were 26.4 times more likely to choose an academic position as a first job.” This is a classic example of correlation not necessarily equaling causation. It is likely that residents who published during residency were more interested in becoming academic radiologists in the first place.

He also said that mandates worked because another paper found that “the institution of a resident research requirement at a university-based orthopedic department led to a 9-fold increase in peer-reviewed manuscripts with the resident co-authors in a three-year period.” Of course it did. Research was mandated. Who knows whether the research was impactful or had any effect on the residents’ careers?

Substitute the word “surgery” for “radiology.” The situation is the same.

Instead of research, surgery residents would be far better off learning how to read a journal article, basic statistics, the nuances of CPT and ICD-10 codes, how to negotiate a contract, and how to manage their personal lives, finances, and debt.