AJS virtual research mentor: A primer for approaching academic development time

Participation in research can be an important element for progression through an academic medical career. Somewhat unique to surgical residency programs is the concept of dedicated research time during the middle of clinical training, also known as academic development time (ADT). Approximately 40% of general surgery training programs offer at least one year of ADT, with less than 10% being mandatory.¹ While many approach this time as a way to enhance their competitiveness for fellowship applications, benefits of participating in research extend far beyond that. In particular, ADT can prepare trainees for the diverse career options that exist within academic surgery.

Evaluating and securing a position for ADT, as well as optimizing productivity during this dedicated time away from clinical duties, can be challenging. This may be especially difficult for trainees in programs where ADT is either a new offering or not required, as well as in hybrid or community-based training programs that may have less existing infrastructure to support resident research than do academic centers. The aim of this article, from the American Journal of Surgery Student and Resident Scholar (STARS) Committee, is to provide a brief framework to inform trainees across all types of training programs how to approach preparation for their ADT experience. We specifically address the decision to pursue ADT, considerations for securing a position, preparing for your time away from clinical responsibilities, and optimizing productivity.

The desire to pursue ADT is multifactorial but often rooted in preparing for the increasingly rigorous fellowship application process.² The advantages of research involvement and productivity on fellowship candidacy in Pediatric Surgery, Complex General Surgical Oncology, and Breast Surgical Oncology have been well-documented.^3–5 ADT can facilitate exploration of different academic niches, including through the pursuit of advanced degrees, and provide an opportunity to cultivate mentorship within a field of interest.^2,6 Beyond this, a resident’s genuine curiosity in the research process should be central to their decision. The ability to devote more time to work-life integration and personal goals may also influence residents’ decisions to opt for ADT.^2,7 Before deciding, it is crucial to be deliberate and clear about how the time away from clinical duties aligns with your personal and professional goals. The opportunity and actual costs of extending your training are not trivial. ADT should offer a significant return on the time you choose to invest.

1. Considerations for securing a research position

Ideally, the earlier in residency you decide to pursue ADT, the better, though deciding “late” does not completely obviate you from this opportunity. Generally, residents are encouraged to make their program directors (PD) aware of their intent between the end of PGY1 and early PGY2 years to allow sufficient time to find a supervising mentor, refine research interests, and explore options for fellowships outside your own institution. Strong mentorship is the cornerstone of a successful research experience. In programs with an established research infrastructure, finding a mentor may be a relatively straightforward process. If you are from a community or hybrid center, however, more initiative may be needed to identify an appropriate mentor. You may also want to consider if a basic science vs clinical position is more in line with your goals; long term career goals, expectations of an intended fellowship, and the amount of time you are permitted to be away from clinical duties are all factors that may contribute to this decision.

If looking to pursue opportunities outside of your home institution, asking program leaders to enlist their professional networks and act as liaisons on your behalf is incredibly beneficial. Additionally, many national surgical organizations provide listings of research fellowship positions or resident grants on their websites (for example, the Association of Academic Surgery, American Society of Colon and Rectal Surgeons, or American Pediatric Surgical Association),^8–11 which can be helpful for residents with fewer intramural resources. Though it may seem daunting, sending targeted emails to listed research coordinators is highly encouraged. Additionally, if you are from an underrepresented background in medicine, the NIH offers an administrative supplement that allows additional funding to a principal investigator (PI) on an R01 award with at least 2 years of funding remaining. Applying for this can provide a financial benefit to the PI in addition to what you offer with your work ethic and skills. Application processes for external positions can vary widely across programs. Some may only require your curriculum vitae and a brief phone call or meeting, while others may ask for a personal statement, ABSITE scores, letters of recommendation, and sometimes multiple rounds of formal interviews. Preemptively collecting all of these documents and being prepared to submit them if prompted is in your best interest, so as not to delay your path to securing a position.

2. Preparing for research time

Leading up to your ADT, take the opportunity to become familiar with the research process. Research can involve generating ideas, performing a literature review, creating a study design, writing protocols, or performing data collection. The more comfortable you can become with the scientific process, the more poised and productive you will be once the formal experience begins. Starting the process for the first time can be daunting, but resources in this realm are abundant – some recommended options are listed in Table 1.

Table 1.

High-yield resources to guide you through the research process.

Performing a Literature Review	Schwartz PB, Christensen L, Zafar SN. How to perform an effective literature review. Am J Surg. 2022 Sep; 224(3):1019–1022.14
Designing a Study	Wang X, Kattan MW. Cohort Studies: Design, Analysis, and Reporting. Chest. 2020 Jul; 158(1S):S72-S78.15
	Dey T, Mukherjee A, Chakraborty S. A Practical Overview of Case-Control Studies in Clinical Practice. Chest. 2020 Jul; 158(1S):S57-S64.16
Writing a Manuscript	Liang TW, Feliciano DV, Koniaris LG. A surgery trainee’s guide to writing a manuscript. Am J Surg. 2017 Sep; 214(3):558–563.17
	Ibrahim AM, Dimick JB. Writing for Impact: How to Prepare a Journal Article. In Markovac J, ed. Medical and Scientific Publishing. Academic Press; 2018:81–92.18
	Cetin S, Hackam DJ. An approach to the writing of a scientific manuscript. J Surg Res. 2005 Oct; 128(2):165–7.19
Creating a Visual Abstract	Ibrahim AM. Seeing is Believing: Using Visual Abstracts to Disseminate Scientific Research. AmJ Gastroenterol. 2018 Apr; 113(4):459–461.20

Entering your ADT with a few study ideas or interests that you would like to pursue can be very beneficial to maximize your productivity. The more proactive and intentional you can be towards your academic interests, the easier it is for your mentor to guide you on how to reach those goals. While at the beginning of your experience it can seem like there is plenty of time ahead to be productive, residents often find that this time passes more quickly than expected. Between the time it takes to receive institutional review board approval, acquire data or run experiments, and perform statistical analysis, the clock is always ticking. Additionally, the more administrative tasks you can complete prior to your ADT, the more time you free up to focus on the actual work at hand. Other tasks to finish prior to embarking on your experience are: completing required institutional modules such as research training certifications, as well as initiating any licensing processes to facilitate expected clinical duties (if required by the program for funding purposes) or moonlighting (if choosing to do so).

3. The research years

If you are not entering your ADT with at least one project planned or in progress with your PI, we recommend setting up an introductory meeting with your mentor to begin this process as early as possible. Your role as research resident can be dynamic and include any step of the research process - protocol design, project coordination, data collection and analysis, and preparing your findings for presentation and publication. The specific details of how to accomplish these are beyond the scope of this paper, though our committee plans to publish a series of future articles addressing each topic. Broadly, the key to an effective and fruitful research fellowship is maintaining several ongoing projects, all in various overlapping stages of completion – think “multiple plates spinning on multiple sticks.” While it may sound exhausting (and sometimes it can be), Table 2 describes our recommendations to keep those plates spinning during your ADT.

Table 2.

Six key principles to help you maximize productivity during academic development time.

Start early and work in parallel	Get IRB applications and study protocols submitted expeditiously (aim for at least 4–6 months before you start ADT). Continue to further your projects in alternative ways while awaiting approval: complete and organize your literature review, craft a sample data sheet, write out the Introduction and Methods sections of your future manuscript.
Establish a system to stay organized	Create a central record of all your ongoing projects and be diligent about keeping it continuously updated. This record should include details such as PI/mentor name(s), IRB status, project phase, actionable items and who they are assigned to, target conference and/or journal. This document should be frequently revisited with each mentor to ensure you are consistently aligned and on the same page. In addition to a project tracker, regularly update your CV with publication and presentation information.
Set targeted goals and deadlines	Set feasible personal deadlines (daily, weekly, monthly, etc.). Centralize a list of conference dates, submission deadlines, and specific abstract limitations/guidelines. Be proactive (but realistic) about setting goals with your mentor about which deadlines you are working towards.
Understand that research is a team sport	Delegation is crucial – use your time for things that are most valuable, and delegate tasks that others can assist you in completing. Make connections with the people in your research department (coordinators, statisticians, assistants, students) who can be great resources for you
Set roles and expectations	For any work that will eventually result in publication, discuss the expected plan for authorship at the beginning of the project Crucial conversations at the onset about expected roles will allow all members to appropriately allocate their time and avoid conflicts regarding unmet expectations once the work has been completed
It’s OK to say no	Understand your own bandwidth – there will always be temptations to continue accepting projects to maximize throughput, but at some point you will sacrifice your ability to finish projects in a timely and high-quality manner if you take on too many projects Protect both your well-being and your professional reputation – once you have taken on a role, make sure to deliver (and say no to other projects if you won’t be able to deliver for them)

4. Return to clinical responsibilities

The return to clinical duties after ADT is both nerve-racking and exciting. Though the scheduling benefits and time for personal life afforded by ADT are a reprieve from the grind of clinical residency, most residents are eager to get back to clinical work. There is no perfect way to prepare for this return, and previous studies demonstrate that both residents and faculty sense some decline in technical or clinicak skills.^12,13 Recognize that you will be rusty and be proactive about getting back into the operating room early and often once you resume your clinical time. We also encourage making liberal use of the simulation center whenever available to refine techniques that can be improved upon outside of the OR. If available with your contract, opportunities for moonlighting or assisting with call coverage may also help with skill retention.

Another issue to address is how to handle incomplete projects. It can be difficult for residents to balance both clinical duties with remaining research projects. While it is certainly reasonable to finish off some of your projects, it is also important to take stock of allocating your time and making a plan. Before returning to a primarily clinical role, you and your PI should discuss expectations about which projects you will complete yourself and the transition plan for passing on other projects to other residents or lab members. It may be difficult to let go of projects, but being realistic and intentional is paramount. Research is a team sport – make the most of your dedicated research time while you have it and build relationships with your lab members so that you have a strong succession plan in place.

ADT is an invaluable adjunct to general surgery training. Regardless of your reasons for pursuing ADT, it is an exciting and formative period in a trainee’s career. Preparing for ADT can be daunting, and we hope this has helped provide a framework for approaching and making the most of your ADT.