Academic outcomes of geriatric medicine theses in internal medicine residency: a 25-year nationwide review in Türkiye

Abstract

Background

This nationwide study evaluated the research topics, methodological characteristics, institutional distribution, and publication outcomes of geriatric medicine-related internal medicine residency theses in Türkiye between 1998 and 2022.

Methods

A total of 234 geriatric medicine-related theses registered in the Turkish Higher Education Council Thesis Center were retrospectively analyzed. Data included thesis design, research topic, institution type (university vs. training and research hospital), and publication metrics (publication status, indexing, publication delay, and authors’ current specialties).

Results

Cross-sectional design was the most common (63.7%). The overall publication rate was 47.4%, with a median publication delay of 2 years (IQR 1–4). Publication rates were higher in university hospitals than in training and research hospitals (51.4% vs. 32.7%, p = 0.002). Methodological theses showed higher publication success (p = 0.019). Publication rates declined from 59.2% in 1998–2014 to 42.3% in 2015–2022 (p = 0.018). Theses authored by future geriatricians had higher publication rates (78.8% vs. 43.3%, p < 0.001). Despite an increase in geriatric syndrome thesis topics, no significant association was found between publication status and thesis categories.

Conclusions

Geriatric medicine has gained increasing academic visibility in internal medicine training in Türkiye. However, declining publication rates and institutional shifts highlight the need for stronger mentorship and structured research support in residency programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08442-7.

Introduction

The global rise in the aging population has elevated geriatric medicine to a prominent role within healthcare systems. As multimorbidity, frailty, and functional decline become increasingly common, internal medicine physicians are expected to meet the complex needs of an aging patient population. National surveys from the United States have highlighted a persistent need to improve geriatric medicine training within internal medicine residency programs, stressing the importance of incorporating structured geriatric education into postgraduate medical education curricula [1]. Many countries have addressed these challenges by incorporating geriatric medicine principles into postgraduate medical education, especially in training programs for internal medicine.

In Türkiye, geriatric medicine is a recognized subspecialty within internal medicine, and completion of a thesis is a mandatory component of internal medicine residency training. While many residents explore topics related to older individuals, there is a gap in research concerning the scope, focus, and academic impact of these theses in geriatric medicine. It remains unclear how often these theses result in scientific publications and which factors affect their distribution.

This study aims to fill the existing gap by reviewing geriatric medicine-related internal medicine theses in Türkiye, analyzing their research themes, publication outcomes, journal quality, and factors influencing dissemination.

Materials and methods

A nationwide retrospective descriptive study was conducted to evaluate geriatric medicine-oriented internal medicine residency theses completed in Türkiye between 1 January 1998 and 31 December 2022. Relevant theses were identified through the National Thesis Center of the Turkish Higher Education Council (YÖK) by selecting the Department of Internal Medicine as the academic unit and geriatric medicine as the subject category on the YÖK Thesis Portal (http://tez.yok.gov.tr/UlusalTezMerkezi/).

For each thesis, information was extracted regarding the year of completion, institution type (university hospital vs. training and research hospital), city, study design, and primary research topic. Each thesis was coded under a single primary (major) topic according to its main research question and outcomes; in overlapping areas, the thesis was assigned to the major topic most directly addressed. Author-related characteristics, including sex, current academic title, and medical subspecialty (if applicable), were also recorded.

To determine publication status, systematic searches were performed using the thesis title, the author’s name, and relevant keywords in PubMed, Web of Science, TR Dizin, and Google Scholar. A thesis was considered published if a corresponding article was found in at least one of these databases. If no match was identified, the thesis was classified as unpublished. For published theses, the Science Citation Index Expanded (SCIE) indexing status and the SCImago Journal Rank (SJR) score of the journal were recorded based on the values corresponding to the year of publication. All data collection and analysis were completed in May 2025.

Statistical analysis

All statistical analyses were performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQRs) for non-normally distributed continuous variables. The normality of distribution was assessed using the Shapiro–Wilk test.

Comparisons between categorical variables were performed using the Pearson chi-square test or Fisher’s exact test, as appropriate. The Mann–Whitney U test was used for the comparison of continuous variables between two independent groups. Effect size measures (e.g., Cramer’s V for chi-square tests) and 95% confidence intervals for proportions (e.g., publication rate comparisons) were considered to better illustrate the strength and precision of associations. A p-value of less than 0.05 was considered statistically significant.

Results

A total of 234 geriatric-focused internal medicine residency theses were analyzed. The overall publication rate was 47.4% (111 theses). The median time from thesis completion to publication was 2 years, IQR (1–4). As presented in Table 1, theses conducted at university hospitals had a considerably higher publication rate (51.4%) compared to those from training and research hospitals (32.7%) (p = 0.002). Likewise, residents who later chose geriatric medicine as a subspecialty had a markedly higher publication rate (78.8%) than those who selected non-geriatric fields (42.3%) (p < 0.001). No significant differences in publication rates were observed by the author’s sex, the city of the institution, or the academic rank of the thesis supervisor.

Table 1.

Comparison of thesis and author characteristics by publication status (n = 234)

Variable	Published (n = 111)	Unpublished (n = 123)	p-value
Gender			0.174
Female	47 (42.7)	63 (57.3)
Institution type			0.002
University hospital	95 (51.4)	90 (48.6)
Training & research hospital	16 (32.7)	33 (67.3)
City of institution			0.312
Ankara	48 (49.5)	49 (50.5)
İstanbul	25 (43.1)	33 (56.9)
İzmir	14 (63.6)	8 (36.4)
Other	24 (42.1)	33 (57.9)
Title of thesis supervisor			0.640
Professor	54 (49.1)	56 (50.9)
Associate Professor	52 (47.3)	58 (52.7)
Dr. Faculty Member	5 (35.7)	9 (64.3)
Subspecialty preference			< 0.001
Geriatric	26 (78.8)	7 (21.2)
Non - geriatric	85 (42.3)	116 (57.7)
Values are presented as n (%). Associations were assessed using the Pearson chi-square test

As summarized in Table 2, most theses were cross-sectional (63.7%), followed by cohort (22.6%) and case-control (6.8%) studies. While publication rates were higher for methodological and interventional designs, only the methodological design was significantly associated with publication status (p = 0.019). No significant association was found between research topic and publication status. In recent years, there has been a notable increase in theses addressing core geriatric syndromes, including frailty, sarcopenia, and polypharmacy. In contrast, studies classified under the “Other” category, which examined age-related clinical outcomes of common internal medicine conditions such as hypertension, diabetes mellitus, thyroid disorders, and various other general conditions, were more frequently observed in the earlier years of the study period.

Table 2.

Comparison of study type and thesis topic by publication status (n = 234)

Variable	Published (n = 111)	Unpublished (n = 123)	p-value
Study type
Cross-sectional	71 (47.7)	78 (52.3)	0.902
Cohort	22 (41.5)	31 (58.5)	0.326
Case-control	6 (37.5)	10 (62.5)	0.41
Methodological	9 (81.8)	2 (18.2)	0.019
Interventional	2 (66.7)	1 (33.3)	0.605
Experimental	1 (50)	1 (50)	0.725
Thesis topic
Frailty	15 (50)	15 (50)	0.772
Dementia	14 (48.3)	15 (51.7)	0.909
Sarcopenia	12 (41.4)	17 (58.6)	0.485
Malnutrition	14 (51.9)	13 (48.1)	0.625
Polypharmacy	6 (40)	9 (60)	0.723
Osteoporosis	5 (55.6)	4 (44.4)	0.868
CGA	2 (33.3)	4 (66.7)	0.055
Incontinence	4 (80)	1 (20)	0.14
Falls	3 (60)	2 (40)	0.265
Delirium	3 (100)	0 (0)	0.105
Palliative care	1 (33.3)	2 (66.7)	0.622
Depression	0 (0)	2 (100)	0.499
Other*	32 (45.1)	39 (54.9)	0.671

Values are presented as n (%). Associations were tested using the Pearson chi-square test or Fisher’s exact test, as appropriate

CGA Comprehensive Geriatric Assessment

*Other This category includes studies focusing on general internal medicine topics such as hypertension, diabetes mellitus, and thyroid disorders

Table 3 outlines the characteristics of the journals in which the theses were published. Most studies appeared in international journals (67.6%) and were indexed in the Science Citation Index Expanded (SCIE) (68.5%). The most frequently used journal was Archives of Gerontology and Geriatrics (12.6%). A total of 78 unique journals were identified, of which 68 had published only one thesis.

Table 3.

Distribution of journal types, indexing status, and top publishing journals for geriatric medicine-related theses

Published theses	n (%)
Journal type
International journals	75 (67.6)
National journals	36 (32.4)
Indexing status
SCIE-indexed journals	76 (68.5)
ESCI-indexed journals	14 (12.6)
TR Dizin-indexed journals	14 (12.6)
Other-indexed journals	7 (6.3)
Journals (highest number of published theses)
Archives of Gerontology and Geriatrics	14 (12.6)
Turkish Journal of Geriatrics	7 (6.3)
European Geriatric Medicine	6 (5.4)
European Journal of Geriatrics and Gerontology	4 (3.6)
BMC Geriatrics	2 (1.8)
Clinical Interventions in Aging	2 (1.8)
Nutrition in Clinical Practice	2 (1.8)
International Psychogeriatrics	2 (1.8)
Journal of Geriatric Psychiatry and Neurology	2 (1.8)
The Journal of Nutrition, Health and Aging	2 (1.8)
Others (< 2)	68 (61.3)

Abbreviations SCIE Science Citation Index Expanded, ESCI Emerging Sources Citation Index, SJR SCImago Journal Rank, TR Dizin Turkish National Citation Index

As shown in Fig. 1, the number of internal medicine residency theses related to geriatric medicine has increased over time, particularly after 2010, despite annual fluctuations. However, this rise in thesis output was not accompanied by a proportional increase in publications. When the study period was divided into two intervals that yielded approximately equal numbers of theses, the publication rate decreased from 59.2% in 1998–2014 to 42.3% in 2015–2022 (p = 0.018). To confirm the consistency of this finding, the data were re-analyzed using an alternative chronological cut-point around the mid-2010s (see Supplementary Table S1). In this analysis, the publication rates were 62.9% before 2010 and 44.7% after 2010 (p = 0.048). A significant change was observed in the institutional distribution of theses. In 1998–2014, almost all theses were completed in university hospitals (98.6%), whereas in 2015–2022, the proportion of university-based theses decreased to 70.6%, and 29.4% were conducted in training and research hospitals (p < 0.001).

Fig. 1.

Distribution of Internal Medicine Residency Theses in Geriatrics by Year and Publication Status (1998–2022)

The annual distribution of journal quality metrics for published theses is shown in Fig. 2. Among the 97 theses with available data, the median Journal Impact Factor (JIF) was 1.68 IQR (0.34–2.92). For 99 theses, the median SCImago Journal Rank (SJR) score was 0.52 IQR (0.18–0.97). Both metrics showed year-over-year variability without a distinct directional trend.

Fig. 2.

Yearly medians and smoothed (3-year moving average) trends of Journal Impact Factor (JIF) and SCImago Journal Rank (SJR) for journals publishing the theses (2000–2025). Abbreviations: JIF = Journal Impact Factor; SJR = SCImago Journal Rank

The cumulative distribution of thesis topics throughout the study period is shown in Fig. 3. In the earlier years, the number of theses addressing specific geriatric syndromes was limited. However, in more recent years, a greater number of theses focused on geriatric syndromes such as frailty, dementia, sarcopenia, malnutrition, polypharmacy, osteoporosis. This reflects an increase in the volume of academic work produced in the field of geriatric syndromes over time.

Fig. 3.

Cumulative distribution of geriatrics-based research topics in internal medicine residency theses from 1998 to 2022. The stacked bar chart displays the cumulative frequency of each topic over time. “Other” represents theses focusing on non- geriatric syndromic internal medicine problems in older adults, such as diabetes, heart failure, or chronic kidney disease

Discussion

This study provides the first comprehensive nationwide analysis of geriatric medicine-related internal medicine residency theses in Türkiye over 25 years. The overall publication rate was 47.4%, with a median time to publication of two years. Previous studies from various medical specialties in Türkiye have reported differing publication rates, including 47.1% in physical medicine and rehabilitation, 38.7% in cardiovascular surgery, 37.7% in psychiatry, 20.5% in general surgery, and 14.9% in orthopedics [2–6]. To date, no global studies have been identified that systematically evaluate the publication outcomes of residency theses in the field of geriatric medicine, highlighting a notable gap in the international literature.

Although the literature presents conflicting findings regarding the effect of institutional setting on thesis publication rates, our study found that theses completed at university hospitals had significantly higher publication rates compared to those from training and research hospitals. This difference can be attributed to several factors. University hospitals generally offer more structured research environments, better access to experienced academic supervisors, and stronger institutional support for scientific productivity. On the other hand, residents in non-university settings often face heavier clinical workloads and fewer opportunities for academic guidance, which can make it more challenging to develop theses into publishable manuscripts. Our findings align with international reports showing that residents’ scholarly output is shaped by structural factors, particularly protected research time, structured mentorship, and program resources. Programs that implement formal research curricula and mentorship frameworks report higher conversion of projects to peer-reviewed publications, whereas heavy workload and limited faculty mentorship are recurrent barriers [7]. In internal medicine cohorts, publication rates of resident projects/abstracts vary widely (often ~ 20–50%) and are influenced by program supports and supervision quality [8, 9]. Collectively, these cross-national observations suggest that strengthening mentorship structures, ensuring protected research time, and maintaining basic research infrastructure are likely to improve publication outcomes across residency systems, not only in Türkiye.

Thesis supervisors play a crucial role in the academic and research development of medical students. A study from Charité Universitätsmedizin Berlin involving 1069 supervisors revealed that 87% felt unprepared for supervision, and significant discrepancies existed between supervisors’ and students’ perceptions of support, particularly regarding statistical guidance [10]. A study from Tunisia showed that only 11.8% of medical theses defended between 2015 and 2017 were published, indicating a need for more substantial support and guidance throughout the research process to improve publication outcomes [11]. These findings suggest that communication gaps and insufficient collaboration are key reasons for thesis failure.

In our study, theses designed with a methodological approach had a significantly higher publication rate (81.8%) compared to other study types. This may be attributed to their higher potential for citation, as methodologically designed studies often present reproducible tools or frameworks that are applicable across various research settings and are more likely to meet the expectations of academic journals.

Residents who later pursued geriatric medicine as a subspecialty demonstrated significantly higher thesis publication rates (78.8%), possibly reflecting their sustained academic interest in the field. A study conducted in the United States among 823 internal medicine graduates found that those who pursued fellowship training demonstrated significantly higher academic productivity, publishing up to 1.2 articles per person-year compared to 0.31 among non-fellowship graduates [8]. This finding suggests a stronger educational focus and continued interest in the field, resulting in more effort to transform theses into publishable manuscripts. This association indicates that career paths can impact scholarly productivity during residency.

Even though the number of theses related to geriatric medicine has increased over time, our analysis did not reveal a corresponding improvement in the quality of journals where these studies were published. A recent global analysis demonstrated that the increasing number of scientific publications is associated with a decline in average journal quality metrics, such as the SJR, suggesting that the trend of quantity potentially compromising quality is not limited to a specific region but is observed worldwide [12]. Journal metrics, such as the Journal Impact Factor and SCImago Journal Rank, exhibited considerable year-to-year variability without a clear upward trend. Furthermore, despite the rising number of theses, the publication rate declined over time from 59.2% in the 1998–2014 period to 42.3% in 2015–2022. This downward trend may indicate increasing difficulties in transforming theses into publishable work, possibly due to increased clinical demands, limited academic guidance, or a reduced emphasis on research in residency training programs. Programs that provide organized research training, continuous mentorship, and clear goals are more likely to turn projects into publications, while lack of supervision and irregular guidance often prevent success [13]. At the same time, increasing clinical workload and time pressure plausibly reduce opportunities for analysis, writing, and submission, as highlighted in qualitative studies of residents’ work intensity and its educational impact [14].

Evidence from a large resident cohort shows that greater scholarly output is positively associated with clinical performance, suggesting research engagement does not detract from training [15]. A national survey of Japanese residents found that engaging in research during residency was associated with higher overall program satisfaction, despite common barriers such as limited time and mentorship [16]. Taken together, these observations reinforce the value of structured mentorship and protected time in residency, aligning with our findings that stronger academic support is likely to improve dissemination of scholarly work.

A progressive shift has been observed in the thematic focus of residency theses, moving from general internal medicine topics to core geriatric syndromes. Over the years, the concept of geriatric syndromes has gained increasing prominence in both academic research and clinical decision-making, with a growing number of studies highlighting their multifactorial nature and critical impact on health outcomes for older adults [17]. In particular, conditions such as frailty, sarcopenia, polypharmacy, dementia, and malnutrition have gained increased prominence in recent years. This trend likely reflects a growing recognition of the multifaceted and interdisciplinary nature of geriatric care, where traditional disease-focused approaches are insufficient to address the complexity of health issues related to aging.

This study has several limitations. Publication status was identified through comprehensive database searches using author, supervisor, and thesis title as separate queries to improve matching accuracy. Nevertheless, some publications may have been missed due to variations in names, title reformulations, translation differences, or indexing inconsistencies. Theses without a corresponding publication were assumed to be unpublished, which could have led to minor misclassification. In light of data constraints, we did not perform multivariable logistic regression because the dataset lacked a sufficient number of distinct and reliable covariates (e.g., detailed mentorship/supervisor metrics, funding, research infrastructure) to support a stable and interpretable model.

Conclusion

This study demonstrates a growing academic interest in geriatric medicine within internal medicine residency training in Türkiye. Although the number of theses has increased and topics have shifted toward core geriatric syndromes, the declining publication rates in recent years highlight the need for improved academic mentorship and research support in residency programs.

Abbreviations

CGA

Comprehensive Geriatric Assessment

ESCI

Emerging Sources Citation Index

IQR

Interquartile Range

JIF

Journal Impact Factor

SCIE

Science Citation Index Expanded

SJR

SCImago Journal Rank

SPSS

Statistical Package for the Social Sciences

TR Dizin

Turkish National Citation Index

YÖK

Yükseköğretim Kurulu (Turkish Higher Education Council)

Authors’ contributions

MT (Mert TOKATLI) initiated the study and was responsible for the conceptualization, methodology, literature search, data extraction, analysis, and drafting of the manuscript. CB (Cafer BALCI) also contributed to the critical review, revision, and editing of the manuscript and approved the final version for submission.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Not needed.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.