Abstract
The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ± 4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ± 11 resulting from 160 ± 90 peer-reviewed manuscripts cited 3998 ± 2516 times. At the time of selection, Godina fellows had an average of 65 ± 42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.
Keywords: Fellowship, Hand, Academic, Surgery, Residency, Microsurgery
1. Introduction
Dr. Marko Godina made important contributions to the field of reconstructive microsurgery before his untimely death at the age of 43.1 Dr Godina pioneered novel techniques for complex extremity salvage through early reconstructive microsurgery.2 Following his death, the American Society of Reconstructive Microsurgery (ASRM) honored Dr. Godina by establishing the Godina lectureship and later the travelling fellowship. This investment promised to expand the careers of committed microsurgeons who espoused the innovative and energetic spirit of the Fellowship's namesake. Through study, research, and travel, each Godina Fellow is expected to expand the horizons of reconstructive microsurgery as an academic discipline. Participants would also benefit by learning unique approaches to complex reconstructive problems practiced at unique centers of excellence around the world.3,4
First established in 1993, seven years after Dr Godina's tragic accident, the Godina lectureship and Fellowship has honored twenty-eight young microsurgeons. Despite the high visibility associated with this prestigious Fellowship, the qualifications and subsequent accomplishments of Godina Fellows are not well described. Describing the academic qualifications of Godina Fellowship recipients may assist future aspiring plastic and reconstructive surgeons in navigating the selection process. At least three letters of recommendation from members of the ASRM or the World Society for Reconstructive Microsurgery are required to apply for the Godina Fellowship.
This study aims to characterize the academic accomplishments of Godina Fellowship recipients from a demographic, academic, scholarly research, and career selection perspective. We hypothesized that Godina Fellows would remain in academic practice and make significant research contributions to the field of reconstructive microsurgery, as measured by the h-index.
2. Materials and methods
The American Society for Reconstructive Microsurgery (ASRM) provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search strategy was utilized to obtain demographic and academic characteristics including career selection (academic vs private), academic rank (assistant, associate, full professor), residency training specialty, and fellowship selection. Academic career was defined as employment as faculty at an academic hospital with a surgical training program. Curriculum vitae were reviewed to characterize future career outcomes including leadership of academic surgery departments and sub-specialty service lines.
Scholarly impact as measured by the h-index was calculated using Scopus (Elsevier, New York, NY). Bibliometrics were calculated in December 2021 and included the h-index, number of peer-reviewed publications, and total number of citations. The h-index is defined as the number of publications (h) that have been cited at least h times each, which has been applied extensively to the field of plastic and reconstructive surgery.5, 6, 7, 8, 9 Previous h-index benchmarks were used to compare h-index values between different academic ranks in plastic surgery and Godina Fellows.5,6 The m-index is calculated by dividing the h-index by the number of years since the author's first publication, which attempts to normalize for age. Additionally, the number of peer-reviewed manuscripts at the time of selection was calculated. The National Institutes of Health (NIH) RePORTER was queried for NIH grants awarded to Godina Fellows.
Descriptive statistics were calculated using GraphPad Prism 6 Software (San Diego, CA). Ordinal data were presented as means ± standard deviation (SD). Comparisons were made using student t tests with Welch's correction. P values < 0.05 were considered statistically significant.
3. Results
One applicant was selected during each year from 1993 to 2020 for a total of twenty-eight Godina Fellows (Table 1). The average age of at appointment was 44 ± 4 years old. Godina Fellowship recipients were predominately male (96%) and from the United States (61%). 21% were European and 18% were Asian. There were no recipients from South America, Africa or Australia. Godina Fellows were Caucasian (71%) and Asian (29%). There were no African American or Hispanic recipients.
Table 1.
Demographic characteristics of godina fellowship recipients.
| Demographic Characteristics | N | % |
|---|---|---|
| Sex | ||
| Male | 27 | 96 |
| Female | 1 | 4 |
| Race | ||
| Caucasian | 20 | 71 |
| Asian American | 8 | 29 |
| African American | 0 | 0 |
| Hispanic | 0 | 0 |
| Age at Selection | ||
| 35-39 | 2 | 7 |
| 40-44 | 16 | 57 |
| 45-49 | 8 | 29 |
| 50+ | 2 | 7 |
| Region of Origin | ||
| United States | 17 | 61 |
| Europe | 6 | 21 |
| Asia | 5 | 18 |
| Total | 28 | 100 |
All recipients possessed an MD degree and 46% had an additional graduate level degree including a PhD (32%) or Master's Degree (14%) (Table 2). Clinical training pedigrees consisted mostly of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 11% completed craniofacial fellowship training. 32% had no additional sub-specialty fellowship training.
Table 2.
Academic characteristics of godina fellowship recipients.
| Academic Characteristics | N | % |
|---|---|---|
| Residency Training | ||
| Plastic Surgery only | 26 | 93 |
| Orthopedic Surgery | 1 | 3 |
| Otolaryngology | 1 | 3 |
| Post Graduate Degree | ||
| MD only | 15 | 54 |
| MD, PhD | 9 | 32 |
| MD, Masters | 4 | 14 |
| Fellowship Training | ||
| No Additional Fellowship | 9 | 32 |
| Reconstructive Microsurgery | 9 | 32 |
| Hand Surgery | 7 | 25 |
| Craniofacial | 3 | 11 |
| Leadership | ||
| Chief of Sub-specialty Service Line | 9 | 25 |
| Chair of Department or Division | 7 | 18 |
| Career Selection | ||
| Academic | 22 | 79 |
| Private | 6 | 21 |
| Total | 28 | 100 |
Most Godina Fellowship recipients ultimately selected academic careers (79%). 18% served as chair of a department or division of a surgical specialty like plastic surgery. Additionally, 25% served as chief of a surgical sub-specialty like hand surgery (Table 2).
The average h-index was 33 ± 11 (Table 3). This was greater than the mean h-index for plastic surgery chairs,15 chiefs,14 full professors,15 associate professors,9 and assistant professors.5 Godina Fellows published on average 160 ± 90 peer-reviewed manuscripts that were cited 3998 ± 2516 times. The average m-index was 1.2 ± 0.4. By the year of selection, Godina Fellows had published an average of 65 ± 42 peer-reviewed manuscripts. There were no NIH grants awarded to Godina Fellowship recipients.
Table 3.
Scholarly output benchmarks for godina fellowship recipients.
| Bibliometrics | Mean | SD |
|---|---|---|
| No. of publications | 160 | 90 |
| No. of citations | 3998 | 2516 |
| h-index | 33 | 11 |
| m-index | 1.2 | 0.4 |
Table 4 displays the top Godina Fellows as measured by the h-index. Of note, four of the top ten Godina Fellows by h-index were from UTMD Anderson. Region of origin, post graduate degree status or additional fellowship training was not associated with higher h-index values (Table 5).
Table 4.
Top ten godina fellowship recipients as measured by the H-index.
| Microsurgery Center of Excellence | Godina Fellowship Recipient | H index |
|---|---|---|
| University of California, Irvine | Gregory R.D. Evans, MD | 50 |
| University Hospital Gent, Belgium | Philip Blondeel, MD, PhD | 49 |
| UTMD Anderson | David W. Chang, MD | 46 |
| Duke University | L. Scott Levin, MD | 45 |
| UTMD Anderson | Mark A. Schusterman, MD | 44 |
| Mayo Clinic | Steve Moran, MD | 43 |
| University of Nevada | William Zamboni, MD | 43 |
| UTMD Anderson | Matthew Hanasono, MD | 42 |
| Chang Gung Memorial Hospital | Ming Huei Cheng, MD | 41 |
| UTMD Anderson | Peirong Yu, MD | 40 |
| Kaohsiung Medical University Hospital | Yur Ren Kuo, MD, PhD | 39 |
aInstitutions are based on positions held during the year of Godina Grant selection.
Table 5.
Characteristics associated with higher levels of scholarly activity.
| Academic Characteristics | N (%) | Average H-index ± SD | P |
|---|---|---|---|
| Region of Origin | 0.507 | ||
| United States | 17 (61) | 34 ± 11 | |
| Europe | 6 (21) | 28 ± 13 | |
| Asia | 5 (18) | 34 ± 8 | |
| Post Graduate Degree | 0.409 | ||
| MD only | 15 (54) | 35 ± 10 | |
| PhD | 9 (32) | 29 ± 11 | |
| Master's | 4 (14) | 31 ± 13 | |
| Fellowship Training | 0.870 | ||
| No Fellowship | 9 (32) | 32 ± 11 | |
| Reconstructive Microsurgery | 9 (32) | 35 ± 8 | |
| Hand Surgery | 7 (25) | 31 ± 12 | |
| Craniofacial Surgery | 3 (3) | 30 ± 20 | |
| Total | 28 | 100 |
4. Discussion
The ASRM established the Godina Fellowship to honor the contributions of Dr. Marko Godina, a Slovenian plastic and reconstructive microsurgeon who was well regarded for his innovations in complex extremity reconstruction.1,2 The Godina Fellowship provides chosen individuals the opportunity to learn from microsurgical centers of excellence around the world.3,4 Awardees concentrate on a particular theme of reconstructive microsurgery, which they have demonstrated early career excellence in extremity reconstruction, lymphatic surgery, or modern techniques in breast surgery. Godina Fellows travel to learn from different microsurgeons that specialize in their area of interest, which creates opportunities to collaborate on research projects and learn novel operative techniques. In this study, we confirmed our hypothesis that most Godina Fellowship recipients remain in academia and make significant scholarly contributions to the field of reconstructive microsurgery. A large percentage of Godina Fellows also obtain leadership positions at departments and divisions of plastic surgery. Importantly however, we could not assess the impact of the Godina Fellowship on academic career outcomes given the retrospective nature of this study. It could be that the selection committee is simply good at selecting future exemplary microsurgeons as opposed to the Godina Fellowship exposing awardees to novel clinical skills and operating techniques during the Fellowship.
Increasingly, clinical expertise in reconstructive microsurgery is obtained through formal sub-specialty fellowship training.10, 11, 12 Among Godina Fellowship recipients, only 32% pursued formal reconstructive microsurgery fellowship training. This finding may reflect previous generations of surgical training, which did not emphasize fellowship training to the same extent. Among contemporary trained plastic surgeons in the U.S., fellowship training has emerged as a critical prerequisite to obtain academic jobs in competitive markets.10, 11, 12 A surprising percentage of Godina Fellowship recipients (43%) obtained leadership positions at academic surgery programs. Many also obtained additional degrees (46%), highlighting the utility of additional skills like basic science research and business administration in departments and divisions of plastic surgery.13,14
Only one woman was selected for the Godina Fellowship over twenty-eight years of existence. Much has been written on the barriers women face in academic surgery in general and plastic surgery specifically including limited mentorship opportunities and increased family responsibilities.15, 16, 17, 18, 19, 20, 21 Reasons for this discrepancy among Godina Fellowship recipients are an important area for future research given the increased scrutiny on diversity and inclusion in plastic and reconstructive surgery. Women are under-represented in reconstructive microsurgery8 and may be further de-incentivized to apply for additional fellowships given the logistical and travel burdens of participating in the year-long program. Our study also highlights the under-representation of racial and ethnic minorities in academic plastic surgery.22, 23, 24, 25 Among Godina Fellowship recipients, there was no Hispanic or African American representation underscoring the overall lack of racial minorities in the field of reconstructive microsurgery. Furthermore, despite the international nature of reconstructive microsurgery there were no Godina Fellowship recipients from Africa or South America, highlighting additional barriers to creating centers of excellence in these geographic regions.
There were several limitations to this study. First and foremost, only certain demographic characteristics and academic accomplishments were analyzed. However, success for a surgeon is often measured along academic, clinical, and teaching domains. Scholarly accomplishments were emphasized in this study due to the limitations of our data sources i.e., curriculum vitae. To supplement these data, external sources like academic websites were consulted, which may have been outdated or erroneous. Future studies should prospectively survey Godina Fellowship recipients to gain additional insights on the impact of the Godina Fellowship on academic careers. The small cohort of grant recipients also left the possibility of beta error in our statistical analyses. It would be meaningful to compare career outcomes of those who applied to the Godina Fellowship unsuccessfully versus those included in our study. Unfortunately, the names of unsuccessful award applicants were unavailable for study. Lastly, there are many other travel fellowships across other surgical disciplines, but the Godina Fellowship is the only one in the field of reconstructive microsurgery.
In summary, Godina Fellowship recipients make significant research contributions to the field of reconstructive microsurgery, as measured through the h-index. Most stay in academia and many obtain leadership positions in departments and divisions of academic surgical training programs.
Declaration of competing interest
The authors have no conflicts of interest to report.
Statement of human and animal rights
This article does not contain any studies with human or animal subjects.
Statement of informed consent
This study received exemption status from the IRB authors due to the publicly available nature of all data.
Statement of funding
The authors have no sources of funding to report.
Acknowledgements
None.
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