Academic development can be defined as the time a trainee spends to purposively develop skills that are necessary for success as a surgical faculty member or health system leader. These skills may include methodologic expertise necessary to create and sustain an independent research program, leadership skills required for directing multidisciplinary or interprofessional teams, or teaching skills necessary to train the next generation of surgeons. In this chapter, we use the term academic development time to be synonymous with the alternate terms “research,” “lab,” or “professional development” time.

Whether leading a multidisciplinary or interprofessional clinical team, a research team, a training program, department, or health system, surgeons are natural and necessary leaders. Purposeful development prepares surgical
trainees to step into these roles and potentially avoid learning the hard way, through failures or negative experiences. While the priority of surgical training programs will always be training excellent clinicians, the integration of academic development is a critical complement to clinical training. Particularly for trainees involved in research, learning to ask and answer important clinical questions develops the clinical knowledge base and enhances problem-solving skills. Further, development of methodologic skills allows for better understanding of clinical data and trials which ultimately enhances the clinical mission. Surgical training does not in and of itself prepare surgeons to be leaders—and some characteristics of training may even hinder professional development—a focused period in developing professional skills can greatly enhance traditional clinical training in surgery.¹

Of the seven large specialties that match more than one thousand candidates in the National Residency Matching Program, General Surgery is the only specialty in which a sizable proportion interrupt their clinical training for dedicated academic development. In a national survey sent to program directors in general surgery, 35% of surgical trainees had participated in at least 1 year of research during general surgery training,² and this proportion is higher among academic training programs.³ As departmental margins have tightened and more trainees are extending clinical training through fellowships, a number of studies have examined the evidence for the benefits of academic development time.

While not every trainee who participates in academic development time will ultimately achieve standing as an independently funded investigator (perhaps by some, the bar by which this time should be measured), a number of studies have documented significant return on investment for both the trainee and their institution. For example, participants in graduate medical education (GME)-sponsored academic development are more likely to have received faculty appointments and federal grants.⁴ This benefit is further supported by the findings of a survey of three academic surgical organizations (Association of Academic Surgeons, Society of University Surgeons, and the American Surgical Association) demonstrating that three-quarters of the membership had performed research during residency.⁵ Other possible benefits include preparation for an academic career, preparation to perform research that is not funded by the National Institutes of Health (NIH), increased chance of obtaining competitive clinical fellowships, and improved patient care skills secondary to improved critical thinking and assessment of the literature.

Dedicated academic development time is defined as a period away from clinical work which may last a few months to several years depending on the goals of the trainee and the flexibility of the training program. The advantage of dedicated time is that it allows the trainee to step away from clinical work and fully focus on academic development. This period can facilitate completion of a longitudinal research or educationally based project, or a formal degree program, such as a Master of Clinical Research or Master of Business Administration. Dedicated time has been shown to be associated with subsequent faculty appointments and external
funding success.⁴ There are also disadvantages of dedicated academic time. First, academic time lengthens surgical training at a time when increasing numbers of trainees are completing fellowships and facing mounting educational debt.

Dedicated time may not be feasible at every training program given needs for clinical coverage and it can be expensive. One study published in 2009 estimated the cost of dedicated research fellowships to exceed $40 million dollars nationally. Dedicated time may occur before a clinical specialty is decided upon by the trainee which can complicate the choice of mentored research.

If pursued, the ideal time for dedicated academic development is debated. Often it occurs after the second or third year of clinical training, but can also occur during fellowship training, and less often during the early faculty years. While the majority of programs requiring trainees to complete dedicated academic development time do not require trainees to seek or obtain external funding, application for funding was significantly correlated with publications during academic development time. Salary, benefits, supplies, and travels costs are most often paid out of departmental funds, institutional training grants such as the NIH T32 award, individual grants from the NIH or societies, and other sources. Traditional training paths are more likely to be funded.

Integrated time with clinical training may occur because a program cannot accommodate dedicated time or a trainee does not wish to prolong training. One advantage of integrated time is that it’s more generalizable to time as a faculty member or practicing surgeon. Learning to advance research objectives in smaller increments of time while balancing clinical work is a major obstacle at the faculty level and having trainees experience this tension earlier could facilitate the development of sustainable work processes. Integrated time would also allow a focus on leadership development that was concurrent with clinical development and may be more “real life” as residents are learning to lead their own clinical teams. The disadvantages of integrated time are that it can be difficult to prioritize academic development over clinical work, particularly when residents are relied upon for service. Logistically, this form of academic development time could require more flexibility in the typical training paradigm where residents are relied upon to participate in clinical work up to 6 days per week.

Historically, academic development during surgical training was exclusively participation in basic or bench research.³ Today, the opportunities are quite diverse, nearly limitless.

The major academic development pathways available to today’s trainees include basic science research, clinical or translational research, health services research or health policy, educational research, innovation, business or administration, information technology, and global health (Figure 21.1). There are numerous core skills necessary for all major pathways as well as skills specific to each.