Structured research training in orthopaedics: A systematic review evaluating its role in career development and academic success

Abstract

Introduction

Structured research training programs during orthopaedic residency and fellowship play a crucial role in career development, enhancing opportunities for academic positions.

Methods

A systematic review was conducted following the Synthesis Without Meta-analysis (SWiM) guidelines. Studies published between 2010 and 2025 were sourced from PubMed, ScienceDirect, and Google Scholar. Articles were screened based on predefined inclusion and exclusion criteria, and data extraction was performed using Rayyan software and Excel from 36 articles which were included. The study was registered with PROSPERO (ID: CRD420251035344).

Results

The review identified multiple interventions, including formal research training, fellowships, and workshops, which were associated with increased research productivity—measured by publication count, citation rates, and h-index scores. Among 10 studies evaluating research training programs, 8 had protected research time and 7 out of 10 such programs showed increased scholarly output. A trend of high h-index and citation volume was observed among fellowship directors across 8 U S programs with a mean h-index of 22.5 and a mean publication count of 91.6. Additionally, structured training improved the likelihood of securing NIH funding and academic positions. However, the direct influence of integrated research training programs on achieving higher academic ranks remained unclear due to factors such as limited data availability, the elapsed time since training, and survey non-response rates. The limitations includes lack of protected research time (n = 7), limited mentorship availability (n = 7),funding constraints and grant accessibility (n = 6) and variation in institutional support (n = 7).

Conclusion

Structured research training during orthopaedic residency and fellowship enhances research productivity and grant acquisition prospects. While its direct effect on academic promotions is influenced by various external factors, incorporating research education into the orthopaedic curriculum fosters scholarly output and cultivates research-oriented clinical scientists.

Graphical abstract

1. Introduction

In modern healthcare, evidence-based medicine has become a cornerstone for clinical decision-making and medical innovation.¹ Integrating research training into orthopaedic residency and fellowship programs presents numerous academic and career-oriented opportunities, allowing trainees to contribute to scientific advancements while enhancing their proficiency in critical thinking and evidence synthesis.²

Orthopaedic surgery, as a highly specialized field, demands both technical mastery and academic scholarship.3, 4, 5 However, traditional residency programs, while proficient in clinical and surgical skill development-often fall short in fostering academic and research curricula. This gap is apparent in the variability of research exposure and insufficient scholarly output with limited preparedness for careers in the field of orthopaedics.

Structured research experiences have significantly enhanced scholarly productivity, increasing the likelihood of securing research grants, publishing in high-impact journals, and achieving long-term career progression in academic medicine.^6,7 Residents who undergo formal research training demonstrate higher publication rates, improved citation metrics, and a greater ability to transition into faculty positions or leadership roles within research institutions in comparison to those without significant research experience.^8,9

The most notable challenges include the demanding clinical workload, lack of accessible mentorship, funding constraints, and the absence of standardized research curricula, all of which hinder residents from engaging in meaningful scholarly activities.10, 11, 12 Given the growing emphasis on academic excellence and the need to cultivate clinician-scientists, evaluating effective interventions that optimize research exposure within orthopaedic training programs is essential.^13,14

The primary objective of this research is to evaluate the impact of structured research training on career advancement, research productivity, and securing academic positions. The secondary objectives include: identifying barriers to effective research training; assessing the effectiveness of a gap year and protected research time; examining the role of mentorship programs and workshops in research proficiency; and determining the most effective intervention methods for integrating research into orthopaedic education.

2. Materials and methods

This systematic review follows the Synthesis Without Meta-analysis (SWiM) guidelines to ensure methodological transparency. To confirm compliance with systematic review standards, the study was registered with PROSPERO (ID: CRD420251035344).

2.1. Search strategy

A comprehensive search was conducted using PubMed, ScienceDirect, and Google Scholar to identify relevant literature published between 2010 and 2025.

• a)PubMed: (“Orthopedic Procedures” [MeSH] OR “Orthopedics” [MeSH] OR orthop∗ OR “musculoskeletal surgery” OR “trauma surgery”) AND (“Internship and Residency” [MeSH] OR “Education, Medical, Graduate” [MeSH] OR “Research Training” OR “Resident Education”) AND (“Protected Research Time” OR “Mentorship” OR “Fellowship” OR “Publication Output”) NOT (“Cardiology” [MeSH] OR “Neurology” [MeSH] OR “Pediatrics” [MeSH] OR “Radiology” [MeSH] OR “Dentistry” [MeSH] OR “Nursing” [MeSH] OR “Veterinary Medicine” [MeSH]).
• b)ScienceDirect: (“orthopedic surgery” OR “musculoskeletal surgery” OR “trauma surgery”) AND (“research training” OR “resident education” OR “graduate medical education”).
• c)Google Scholar: (“Orthopedics” OR “Orthopedic Surgery” OR “Orthopaedic Surgery”) AND (“Research Training” OR “Resident Education”) -“review” -“systematic review” -“editorial” -“report” -“meta analysis.

2.2. Study selection

The inclusion criteria were studies involving orthopaedic surgery residents, fellows, or postgraduate trainees; articles analysing structured research training programs; comparative studies assessing pre-vs. post-research training implementation; original research, including RCTs, cohort studies, cross-sectional studies, qualitative, or mixed-methods studies; and publications from 2010 to 2025. The exclusion criteria were studies on non-orthopaedic specialities unless orthopaedic-specific data were separately reported; articles not evaluating research training effectiveness or research productivity outcomes; systematic reviews, meta-analyses, scoping reviews, editorials, commentaries, opinion pieces, case reports, or case series; and non-English publications.

The screening process was conducted using Rayyan, a web-based systematic review tool enabling efficient collaboration. Titles and abstracts were independently screened by two reviewers, and full-text articles meeting the inclusion criteria underwent further assessment. Any discrepancies were resolved through discussion and, if necessary, consultation with a third reviewer.

2.3. Data extraction

Data extraction was performed using a standardized form developed in Rayyan and Microsoft Excel, capturing: study characteristics: author, year, study design; resident demographics: sample size, gender; interventions applied: protected research time, formal research training programs, curriculum-based research education programs (e.g., courses on study design, statistics, scientific writing), mentorship programs, research fellowships, workshops, residency programs with academic pathways emphasizing research productivity, and simulation-based research training; outcomes assessed: number of publications pre-vs. post-training, research quality, pursuit of academic/research careers, barriers and enablers, academic positions secured; and additional metrics: Hirsch (h) index, citation impact, residency match rates, comparison groups, barriers to research engagement. Data extraction was independently conducted by four reviewers, with any disagreements resolved through consensus discussion.

2.4. Risk of bias assessment

Methodological quality assessment was performed using the Newcastle-Ottawa Scale (NOS), which evaluates risk of bias across five domains: randomisation process; deviations from intended interventions.; missing outcome data; measurement of outcomes; selection of reported results. Each domain was categorised as low, high, or unclear risk of bias, with assessments independently conducted by two reviewers, resolving discrepancies through discussion.

2.5. Statistical analysis

2.5.1. Strategy for data synthesis and subgroup analysis

Given anticipated heterogeneity in study designs and outcomes, a narrative synthesis approach was employed. Qualitative analysis identified common themes, trends, and patterns related to: research productivity (h-index, publication count, citation impact); effectiveness of interventions applied; and long-term academic outcomes assessed.

3. Results

3.1. Study characteristics

A total of 1700 articles were initially identified through database searches. After removing 34 duplicates and 367 articles via automation tools, 1299 titles and abstracts were screened for initial eligibility. Following predefined inclusion and exclusion criteria, 247 studies were selected for retrieval, of which 164 were excluded, leaving 83 articles for full-text screening.

After full-text review, 39 studies were excluded due to irrelevant populations, non-aligned outcomes, or publication type. Forty-four studies remained for data extraction; however, eight additional studies were excluded—four due to the lack of simulation/cadaveric skill transfer to real-life scenarios and four due to irrelevant outcome measures identified via citation tracking. Ultimately, 36 studies were included in the final analysis, as shown in Fig. 1. These studies, published between 2010 and 2025, comprised cross-sectional studies (n = 25), retrospective cohort studies (n = 6), prospective cohort studies (n = 2), and qualitative studies as shown in Table 1.

Fig. 1.

PRISMA flow diagram of inclusion of studies in the analysis.

Table 1.

Characteristics of studies included in the analysis.

Study Author Name	Publication Year	Place of study	Nature of Study	Interventions Analysed	Major Findings
Gregory R. Toci15	2020	USA	Cross-Sectional Study	Research productivity and residency matching	Publishing research significantly improves matching into higher-ranked residency programs.
Haley Ehrlich16	2021	USA	Cross-Sectional Study	Gender distribution among editorial boards	Women received fewer grants/publications; only 6.2 % of editorial boards comprised female members.
M. Lane Moore17	2021	USA	Cross-Sectional Study	Fellowship director selection criteria	High h-index and publication count strongly correlated with male faculty director roles.
Marvin Carr18	2022	USA	Cross-Sectional Study	Research output among residency graduates	Residents pursuing fellowships exhibited higher publication rates and first-author publications.
Muhammad Ali Elahi19	2021	USA	Cross-Sectional Study	Diversity among Foot & Ankle Fellowship Directors	Fellowship director roles favored candidates with institutional loyalty and high research activity.
Jacob Smith20	2022	USA	Cross-Sectional Study	Shoulder & Elbow Fellowship Research Productivity	Expansive networking and institutional legacy influenced success in securing fellowship director positions.
Nicholas R. Williams21	2024	Canada	Cross-Sectional Study	Research output in Arthroplasty Fellowships	Top 10 fellowships contributed 49 % of total publications, showing research disparities across programs.
Nicholas Siegel22	2020	USA	Cross-Sectional Study	Research productivity in hand surgery fellowships	Plastic surgery residents had higher research productivity than orthopaedic trainees, influencing match rates.
Emmanuel K. Konstantakos23	2010	USA	Cross-Sectional Study	Research Team program effectiveness	Structured research education enhanced IRB approval experience and manuscript preparation skills.
Chad A. Krueger24	2016	UK	Cross-Sectional Study	Impact of protected research time	No significant difference in publications among programs with or without mandatory research years.
Brian D. Hosfield25	2019	USA	Cross-Sectional Study	NIH K08 Award application trends	Early exposure to research created gaps in NIH K08 applications, affecting momentum post-residency.
Michael H. McCarthy26	2020	USA	Cross-Sectional Study	Spine bioskills curricula	Financial constraints and delayed skill acquisition affected bioskills implementation outcomes.
Aaron M. Brandt27	2017	USA	Retrospective Cohort Study	Impact of Clinician-Scientist Training Programs	Research residents had higher publication rates during residency but faced challenges post-training.
Laura Robbins28	2013	USA	Cohort Study	Restructuring research curricula	Publications increased significantly after restructuring residency programs; mentorship and funding were key.
Surena Namdari MD29	2010	USA	Retrospective Cohort Study	Impact of 80-h work week on publications	Research output significantly increased post-implementation of 80-h work restrictions.
Peter M. Formby30	2015	USA	Cross-Sectional Study	Research productivity at adult reconstruction fellowships	Top 10 institutions accounted for 65.9 % of total fellowship publications, showing concentration of research.
Seth R. Cope31	2017	USA	Cross-Sectional Study	Factors influencing research productivity in Shoulder & Elbow fellowships	Faculty career length more predictive than institutional factors for research output.
Hannah K. James32	2019	UK	Qualitative Study	Effectiveness of cadaveric simulation training	Significant improvement in operative confidence among PGY4 residents with limited prior experience.
Mara L. Schenker33	2016	USA	Cross-Sectional Study	Structured residency selection criteria	Research played a role in initial ranking but non-cognitive domains influenced final placement.
Patrick M. Osborn34	2018	USA	Retrospective Cohort Study	Effect of faculty longevity on research productivity	Faculty with >10 years tenure produced significantly more publications than faculty with <10 years tenure.
Elisabeth H. Geraghty35	2023	USA	Cross-Sectional Study	Factors valued by applicants in sports medicine fellowships	Faculty reputation ranked higher than research opportunities by applicants.
Sean C. Clark36	2021	USA	Cross-Sectional Study	Protected research time and research assistant impact	Fellows averaged 1-2 publications per fellowship year; programs with research assistants had higher output.
Dean C. Perfetti37	2020	USA	Retrospective Cohort Study	Impact of academic teaching hospitals on surgical outcomes	Teaching hospitals had lower reoperation rates and shorter length of stays compared to non-teaching hospitals.
Alvin W. Su38	2023	USA	Cross-Sectional Study	Barriers in research training (POSNA Initiative)	Lack of funding (82.4 %) and insufficient research training (70.6 %) were identified as primary barriers.
Christopher N. Dijanic39	2022	USA	Cross-Sectional Study	Relative citation ratio among spine surgery faculty	Higher citation ratios correlated with career longevity; male faculty had higher RCR than female faculty.
Ivan Bandovic40	2024	USA	Retrospective Cohort Study	Impact of Scholarship Initiative Program	Peer-reviewed publications increased significantly among residents and faculty post-initiative.
Hernan A. Prieto41	2020	USA	Retrospective Cohort Study	Interactive learner-centered curriculum impact	Resident research productivity increased significantly with journal clubs, bioskills labs, and structured mentorship.
Mohamed F. Albana42	2023	USA	Cross-Sectional Study	DO vs. allopathic match rates in adult reconstruction fellowships	DO publication increase correlated with DO fellowship match rates, whereas allopathic publications showed no correlation.
Joseph Lopez43	2015	USA	Cross-Sectional Study	H-index association with academic rank	Higher h-index correlated with promotion to assistant, associate, or full professor positions.
Brandon E. Earp44	2019	USA	Prospective Cohort Study	Impact of B.O.N.E.S initiative	Female mentorship and orthopedic exposure improved match rates among female medical students.
Clifton Meals45	2015	USA	Cross-Sectional Study	Fellowship applicant selection criteria	Research was ranked lower than personality traits and personal recommendations for selection.
Riccardo D'Ambrosi46	2025	UK	Cross-Sectional Cohort Study	Impact of knee fellowships on clinical and scientific activity	Significant increase in publications and conference presentations post-fellowship completion.

3.2. Risk of bias assessment

Methodological quality was systematically assessed using the Newcastle-Ottawa Scale (NOS). Of the included studies, 19 were rated as high quality, demonstrating strong methodological rigor with minimal risk of bias. Seventeen studies were classified as medium quality, indicating minor methodological limitations but overall reliability. No studies were rated as low quality, reinforcing the robustness of this systematic review.

3.3. Characteristics of research training interventions

Interventions enhancing research productivity and training were classified into three main categories: Research Training Programs (n = 10); Fellowships (n = 3); and Bioskills Programs (n = 3).

Among these interventions, protected research time was present in 8 studies. When comparing pre-vs. post-intervention publication rates, 7 out of 10 research training programs showed increased scholarly output. Out of the six studies which had an established mean increase in number of publications, a mean increase of 5.76 publications was observed among those 6 studies. However, some limitations—discussed in the barriers section—affected overall results.

Protected research time directly contributed to higher publication rates in 5 out of the 8 studies. Additionally, implementation of structured research programs fostered an increase in journal clubs, mentorship, learner-centered educational strategies, financial incentives, statistical assistance, technical support, and work-hour restrictions, all positively influencing manuscript preparation, citation counts, institutional review board (IRB) approval experience, and structured research education.

Faculty longevity was identified as a critical factor affecting the effectiveness of protected research time. Institutions with faculty members having 10+ years of tenure exhibited higher publication rates compared to those with faculty members serving fewer than 10 years.

3.4. Role of research and other factors in residency and fellowship matching

Seven studies assessed the role of research experience in residency and fellowship matching. One study found that having at least one or more publication significantly improved matching rates into higher-ranked residency programs. A mean of 1.1 publication per intern was observed while applying for Orthopaedic residency match. Applicants for fellowship programs were selected based on research productivity Another highlighted that greater research exposure correlated with successful placement into competitive orthopaedic programs based on NIH funding allocations. 6 orthopaedic surgeons among 71 surgeons (all specialities) were awarded with the NIH K08 mentored career development award between 2013 and 2017. This emphasizes that delayed research exposure among surgeons may hinder early grant success in comparison to clinicians in the field of medicine. Screening criteria for residency applicants included five domains: cognitive skills; affective attributes; thematic evaluations; impression-based assessments; and research experience.

Although research played a role in initial rank list preparation, non-cognitive factors such as personality traits and recommendations influenced final placements. Institutional networking and faculty reputation were also key determinants in two studies. Additionally, applicants with a plastic surgery background demonstrated greater research acumen than those from orthopaedic surgery, skewing match rates toward plastic surgery trainees.

The direct immediate impact on resident's next step in career was assessed in 3 studies ranging from 6 months to 2 years post-residency based on placement into academia even though the direct impact couldn't be assessed objectively as a result of the intervention. A mean 27.2 % of all the individuals who underwent research training interventions in those 3 studies entered academia/academic placements. It was observed that structured research training interventions with protected research time were correlated with an increased incidence of residents pursuing or securing academic positions within 3–5 years post intervention in 6 studies assessing this outcome.

3.5. Research's impact on securing academic positions and scholarly involvement

Surgeons with high citation rates were positively correlated with securing higher academic positions. 5 studies assessing the above relation found that a mean of 1848.18 citations per individual was observed in an individual in a high ranking academic position. A trend of high h-index and citation volume was observed among fellowship directors across 8 U S programs with a mean h-index of 22.5 and a mean publication count of 91.6. Directors were often affiliated with institutions renowned for research-focused curricula. Increased research engagement during fellowship strongly correlated with future academic pursuits, first-author publications, and higher h-index scores.

Institutional legacy and networking within specific orthopaedic subspecialties (e.g., shoulder and elbow surgery) were found to influence success in securing fellowship board director positions. Completion of fellowship programs was associated with increased publication rates, greater participation in scientific societies, and more conference presentations.

Interestingly, the timing of research training impacted K08 award applications. Early exposure to research during residency correlated with lower application rates for faculty-level grant awards. Career longevity was positively associated with higher relative citation ratios, reinforcing the long-term benefits of structured research education.

3.6. Barriers to research training and academic advancement

Among the 16 studies assessing interventions for improving research training, the most common barriers included: lack of protected research time (n = 7); limited mentorship availability (n = 7); funding constraints and grant accessibility (n = 6); variation in institutional support and accessibility (n = 6); and low interest in research among residents (n = 2).

Additional challenges included gender disparities (n = 3) and minority underrepresentation in leadership positions (n = 2). Institutional initiatives such as B.O.N.E.S have sought to encourage women to pursue orthopaedic surgery, helping mitigate disparities in research leadership.

4. Discussion

4.1. Impact of structured research training

Orthopaedic residency is a highly demanding and competitive field, ranking alongside plastic surgery and neurosurgery as one of the most research-intensive specialties. Over the past decade, the demand for clinician-scientists has grown substantially, underscoring the importance of integrating structured research training into residency curricula. Research engagement has increasingly been recognized as a critical competency, correlating with higher academic positions, including fellowship director roles. Residents with robust research productivity not only secure higher-ranked academic posts but also remain actively involved in scientific societies and conferences, reinforcing the long-term benefits of early research exposure.^14,47

Multiple interventions have been explored to assess the role of research training in orthopaedic education, particularly its influence on academic advancement and scholarly engagement. Successfully incorporating research into residency requires an inter-sectoral approach, combining protected research time with effective mentorship to maximize the impact of structured training programs. Notably, mentorship longevity has been identified as a crucial factor in enhancing research outcomes, with long-term institutional mentors contributing more effectively to resident development. Additionally, providing financial support for publication costs, statistical assistance, and technical aid could alleviate the burden on trainees, increasing research participation and submission rates. Structured initiatives such as journal clubs and quarterly mentorship meetings further improve the utility of protected research time, ensuring continued engagement and accountability among residents.^2,48, 49, 50

4.2. Barriers to research training

However, disparities in research output across institutions suggest that the extent of research integration varies widely. In the United States, the top 10 fellowship programs in Adult Reconstruction and Arthroplasty collectively contribute 49 % of the total research publications, whereas the bottom 50 % of programs account for only 9 %, reinforcing the notion that research productivity within this subspecialty is primarily fellow-driven. Funding constraints remain a significant barrier, particularly among lower-ranked programs, limiting access to essential research infrastructure and mentorship. Addressing this disparity requires a systematic approach, ensuring equitable research training across all residency programs through evidence-based curricula and institutional funding.⁵¹

To establish a more uniform research framework, dedicated research time should be standardized across all training institutions, accompanied by targeted funding initiatives to support integrated research programs. Structured mentorship should be prioritized, ensuring accessible guidance for residents at key stages of their research development.

4.3. Integration of inter-disciplinary and advanced scientific components

Additionally, bioskills labs could bridge the gap between laboratory training and real-world clinical applications, facilitating studies on training modules, skill assessment rubrics, and comparative teaching methods. An interdisciplinary teaching approach involving biomechanics is foundational for understanding the significance of joint mechanics and prosthetic performance in research education to translate these principles to clinical practice (12). Proficiency in machine learning, predictive analytics and computational simulation will be crucial for future orthopaedic surgeons as these skills play a vital role in transforming diagnostics and predicting patient-specific planning and outcome prediction. (13) This concept of engineering medicine model proposed by Wu et al. integrates AI, data sciences and computational analysis into clinical orthopaedic, encourages their addition into current research curricula. These interventions would not only improve research engagement but also strengthen competency-based education within orthopaedic residency.^50,52,53

Future studies should focus on prospective designs and long-term follow-up analyses to evaluate the sustained impact of research training interventions. Standardizing outcome measures and promoting greater diversity and equity in academic advancement are equally important in shaping the next generation of clinician-researchers. Survey-based cross-sectional studies should be supplemented by long-term cohort analyses, tracking research productivity, publication rates, and academic excellence over time to provide a more definitive evaluation of training effectiveness. Importantly, earlier access to structured research could potentially shorten the timeline for achieving higher academic positions, ensuring that well-trained clinician-scientists enter leadership roles sooner.

5. Limitations

Despite the comprehensive nature of this review, certain limitations must be acknowledged. The heterogeneity in study designs, ranging from cross-sectional to cohort studies, makes direct comparisons challenging and limits causal inferences. Selection bias may be present, as research-focused institutions are likely overrepresented. Variability in reported outcomes, including publication rates and faculty progression, affects result consistency, while recall bias in self-reported data may influence findings. Funding disparities significantly impact research productivity, with well-resourced programs demonstrating higher output. Additionally, while research training contributes to academic success, non-cognitive attributes such as mentorship, networking, and institutional prestige also play a role, yet are underreported. Future studies should focus on prospective designs, standardizing outcome measures, and expanding diverse institutional representation to improve generalizability and long-term assessments of structured research programs.

6. Conclusion

Structured research training is essential for advancing orthopaedic residency and fellowship programs, significantly enhancing academic engagement, research productivity, and career progression. This review underscores the value of protected research time, mentorship programs, and financial support, all of which contribute to higher publication rates and scholarly participation measured by citation rates, h-index and publication counts. However, institutional disparities in research infrastructure and funding affect consistency in outcomes across programs. While research training is positively correlated with By prioritizing research as a core component of residency education, institutions can cultivate leaders in innovation and medical advancement.

Patient consent

Not applicable.

Prospero registration no

CRD420251035344.

Credit author statement

a) Conceptualization – MJ and AN; b) Manuscript writing –; TM and NJ; c) Manuscript revision – SM; d) Data acquisition –; TM and NJ; and e) Data analysis –; SM and MJ. All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.

Consent form

Not applicable.

Ethical statement

Not applicable.

Use of AI

No.

Funding sources

Nil.

Declaration of competing interests

MJ, NJ, and SM are an Editorial Board Members of JCOT. MJ, NJ, AN, and SM are special issue editors for VSI – Medical Education in Orthopaedics in JCOT and were not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.