Research productivity of ophthalmology residents in Saudi Arabia: A comprehensive analysis

Abstract

PURPOSE:

The purpose of the study was to assess the research productivity of ophthalmology residents in Saudi Arabia and identify factors associated with significant research output.

METHODS:

This is a cross-sectional study of ophthalmology training programs across Saudi Arabia from 2015 to 2019.

RESULTS:

The study included 225 ophthalmology residents, with a mean number of publications of 3.25 ± 4.59 and an average h-index of 1.20 ± 1.38. Statistically significant differences were observed between training programs in the mean number of publications (P < 0.001), h-index (P < 0.001), and citations (P < 0.001). The programs with the highest mean publication counts were King Saud University (8.03 ± 8.00), King Khaled Eye Specialist Hospital (3.80 ± 3.87), and the Eastern program (3.07 ± 4.04). Residents pursuing subspecialty fellowships, particularly in oculoplastic surgery and cornea, exhibited higher research output. Furthermore, the mean number of publications (P < 0.001), citations (P < 0.001), and h-index (P < 0.001) were associated with attaining future academic positions. Pursuing fellowship was significantly linked to the number of publications (P = 0.009) and h-index (P = 0.012).

CONCLUSION:

This study underscores the variability in research productivity among ophthalmology residents and highlights the influence of training programs, fellowship ambitions, and academic aspirations on research output.

INTRODUCTION

The training and career pathways of ophthalmologists are crucial in addressing the growing demand for specialized eye care.[1] Research involvement during residency not only enhances critical appraisal abilities but also contributes to the delivery of high-quality patient care.[2,3] Importantly, participation in research during training has been shown not to compromise clinical performance.[4] Ophthalmology is one of the most competitive specialties, with limited residency positions and low match rates.[5] The increasing interest in ophthalmology fellowships has further intensified the competitiveness of the match process.[5,6] Given the rising competition to enter the field, the number of publications by ophthalmology applicants among medical students is expected to grow. In Canada, for instance, the number of papers authored by first-year ophthalmology residents doubled between 2010–2016 and 2017–2022.[7] From residency to fellowship training and subsequent employment in clinical or academic roles, these pathways not only shape individual careers but also strengthen the healthcare system’s capacity to address and manage ocular diseases effectively.

While many ophthalmology trainees engage in research, the current literature lacks quantitative baseline information on their research activity in Saudi Arabia. Local studies have examined ophthalmology residents’ satisfaction with their clinical and surgical training,[8] but no assessments have been made on the outcome of their research training. Analyzing trainees’ research productivity can help academic leaders in ophthalmology identify gaps within the research component of training programs. In addition, assessing factors associated with research productivity can guide future trainees and aspiring ophthalmologists in planning and enhancing their careers.

The aim of the study is to assess research productivity within ophthalmology training programs in Saudi Arabia. It also seeks to evaluate the factors associated with significant research productivity.

METHODS

This cross-sectional study included 225 ophthalmology residents who trained from 2015 to 2019. The list of residents was obtained from the Saudi Ophthalmology Basic Science Course Program, organized by the Ophthalmology Department at King Saud University (KSU). Service residents who were not enrolled in training programs and those from outside Saudi Arabia were excluded. Data collected included basic demographics and the following educational information: Undergraduate medical school, residency training program, year of program entry, fellowship training (if applicable), academic appointment, number of publications, number of citations, and h-index. Elsevier’s Scopus database was used to obtain research metrics for each trainee. The h-index is a measure of research productivity, representing the number of publications (h) that have each been cited at least h times.[9] Study participants were contacted to confirm their medical school where they have graduated from, their residency training program, fellowship training, and academic appointment.

The data were recorded in a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA) and subsequently analyzed using the Statistical Package for the Social Sciences (SPSS) version 29.0 (IBM Inc., Chicago, IL). Categorical data were presented as frequencies and percentages, while numerical data were expressed as means and standard deviations. An analysis of variance (ANOVA) test was performed to compare group means, while a Chi-square test was used to analyze differences in frequencies between groups. Statistical significance was defined as P ˂ 0.05.

RESULTS

The study included 225 ophthalmology residents from 2015 to 2019: 134 male residents (59.6%) and 91 female residents (40.4%). The mean number of publications was 3.25 ± 4.59, the mean number of citations was 16.73 ± 5.00, and the mean h-index was 1.20 ± 1.38. Publications were produced over an average period of 3.52 ± 2.92 years. Fifty-seven residents (25.33%) did not have any publications, while 12 residents (5.33%) had more than 10 publications. There was no difference based on gender in the number of publications (P = 0.840), citations (P = 0.668), and h-index (P = 0.871).

There was a statistically significant difference between different residency training programs and the following: mean number of publications (P < 0.001), h-index (P < 0.001), and number of citations program (P < 0.001). The top three programs with the highest mean number of publications were the KSU (8.03 ± 8.00), the King Khaled Eye Specialist Hospital (KKESH) program (3.80 ± 3.87), and the Eastern province program (3.07 ± 4.04) [Table 1]. Graduates of King Saud bin Abdulaziz University for Health Sciences (KSAUHS) had the highest mean number of publications (5.33 ± 8.28), followed by KSU (4.67 ± 4.45) and the Imam Mohammad ibn Saud Islamic University (3.44 ± 2.40) [Table 2]. The mean number of publications (P < 0.001), number of citations (P < 0.001), and h-index (P < 0.001) were associated with obtaining a future academic position. Pursuing a fellowship was associated with the number of publications (P = 0.009) and the h-index (P = 0.012) [Table 3].

Table 1.

Measures of research productivity for each residency training program

Program	n	Mean number of publications±SD	Mean h-index±SD	Mean number of citations±SD	Mean years of publishing±SD
King Khaled Eye Specialist Hospital	44	3.80±3.87	1.57±1.44	16.82±21.51	4.21±3.04
King Saud University	29	8.03±8.00	2.41±1.68	48.86±79.87	4.97±2.67
Riyadh Joint Program	38	1.26±1.43	0.70±1.10	10.42±18.21	2.55±2.97
The Eastern Program	43	3.07±4.04	1.12±1.16	16.14±27.32	2.95±2.87
The Western Program	39	2.62±3.33	0.95±1.19	8.90±15.96	3.81±2.56
Aseer	15	1.13±1.92	0.33±0.72	2.53±5.15	1.63±2.72
Madinah	9	2.11±2.32	1.00±1.32	10.00±13.74	2.17±2.23
Taif	6	1.00±0.89	0.33±0.52	1.33±1.97	1.75±2.06

Table 2.

Measures of research productivity for graduates of medical schools with the largest number of trainees in ophthalmology

University	n	Mean number of publications±SD	Mean h-index±SD	Mean number of citations±SD	Mean years of publishing±SD
Imam Abdulrahman bin Faisal University	17	3.06±3.31	1.00±0.87	7.65±7.84	2.69±2.65
Imam Mohammad Ibn Saud Islamic University	9	3.44±2.40	1.56±1.51	16.22±15.13	4.50±2.56
King Abdulaziz University	16	3.25±2.44	1.73±1.39	21.31±24.78	4.00±3.09
King Faisal University	8	1.25±1.04	0.50±0.54	5.13±7.75	1.20±1.79
King Saud bin Abdulaziz University for Health Sciences University	30	5.33±8.28	1.67±1.79	27.40±45.82	3.43±2.63
King Saud University	46	4.67±4.45	1.93±1.48	30.48±60.08	5.05±2.81
Qassim University	6	2.17±4.36	0.50±1.23	8.67±14.14	2.67±4.62
Taibah University	11	1.27±1.10	0.55±0.82	8.91±12.62	1.13±2.48
Um Al Qura University	9	2.00±1.66	0.78±0.83	4.33±5.29	2.33±1.86

Table 3.

Comparison of research metrics between trainees with and without fellowship training

	No fellowship, mean±SD	Fellowship, mean±SD	P
Number of publications	1.23±1.60	3.57±4.15	0.009*
h-index	0.59±1.01	1.35±1.36	0.012*
Number of citations	8.68±20.24	18.67±38.71	0.236
Publishing years	2.92±2.87	3.66±2.90	0.382

*Statistically significant at a P<0.05. SD: Standard deviation

There was a significant difference between different fellowship subspecialties and the mean number of publications (P = 0.017) and mean h-index (P = 0.019). Residents who pursued fellowship training in oculoplastics had the highest mean number of publications (5.74 ± 5.27), followed by cornea (4.41 ± 5.49) and then vitreoretinal surgery (3.70 ± 3.49) [Table 4]. Twelve trainees (5.33%) completed fellowship training in the US or Canada. The mean number of citations was significantly higher in trainees who obtained international fellowship training (46.82 vs. 16.25, P = 0.009); however, the number of publications (P = 0.128), the mean h-index (P = 0.171) and the average publishing years (P = 0.093) did not differ significantly.

Table 4.

Measures of research productivity according to the fellowship subspecialty

Subspecialty	n	Mean number of publications±SD	Mean h-index±SD	Mean number of citations±SD	Mean years of publishing±SD
Cornea	49	4.41±5.49	1.51±1.46	20.24±35.86	4.12±3.27
Glaucoma	27	2.56±2.65	0.89±1.05	15.74±21.75	3.70±2.62
Medical retina and uveitis	25	2.12±2.30	0.92±1.06	7.88±10.51	3.44±2.85
Oculoplastic surgery	23	5.74±5.27	2.09±1.59	41.70±87.71	4.48±2.82
Pediatric ophthalmology	25	2.40±2.10	1.16±1.21	9.80±13.73	2.55±2.65
Vitreoretinal surgery	30	3.70±3.49	1.47±1.38	18.00±22.86	3.42±2.72

SD: Standard deviation

DISCUSSION

The findings of this study provide valuable insights into the research productivity of ophthalmology residents in Saudi Arabia, highlighting key factors associated with academic and research success. A notable variation was found across training programs, fellowship pursuits, and academic appointments.

The significant differences in research productivity between residency training programs emphasize the role of institutional support and mentorship in fostering research engagement. The KSU ophthalmology program demonstrated a notably higher mean number of publications, which may reflect the availability of research resources such as equipped research laboratories, research guidance, and a supportive culture of scholarly activity. In a bibliometric study on ophthalmology research in the region from 1980 to 2019, KSU, followed by KKESH, had the largest number of publications.[10] This reflects the research infrastructure and active academic environments at these institutions. Funding and academic promotion incentives are other factors that may contribute to the variation in research productivity among different institutions. In Canada, it was found that large ophthalmology departments produced greater research output and received more federal funding.[11]

Residents who pursued fellowship training had a significantly higher number of publications and h-index. A similar trend was observed in Canada, with residents who opted for fellowship training having significantly more publications compared to those pursuing comprehensive practice.[12] This may indicate that research productivity is a contributing factor in fellowship acceptance and also highlights the ability of fellowship training to enhance research productivity. Trainees who entered academia achieved a significantly higher number of publications, citations, and h-index. In Canada, similarly, trainees who pursued academic practice had a higher number of publications compared to those who entered community practice.[12] In the US, academic ophthalmologists with fellowship backgrounds had a significantly higher h-index than nonfellowship-trained ophthalmologists.[13] In the current study, there was no significant difference in the number of publications or h-index between those who undertook local and international fellowship training. Similarly, there was no significant difference among Canadian ophthalmology residency graduates who chose Canadian, American, or international fellowship programs.[12]

There was a significant difference in research activity among graduates from different medical schools. Graduates of KSAUHS, followed by KSU, had the highest mean number of publications and h-index. It remains unclear whether the medical school background has a greater impact on research productivity than the residency program. A study from the United States found that residency training, rather than medical school, is the primary factor influencing research activity among ophthalmology residents.[5] Another study reported that 54% of residents without preresidency publications were able to publish during their residency.[14]

Graduates who pursued fellowship training in oculoplastic surgery had the largest mean number of papers. In the US, uveitis fellows and oculoplastic surgery fellows had the largest median number of publications.[6] This variability is likely influenced by the number of available positions and the interest of candidates in research. In some countries, oculoplastic surgery fellowship programs have limited seats and may require applications several years in advance. This creates competition, which could enhance the research profiles of graduates.

To improve research productivity within ophthalmology programs, several steps can be undertaken. First, integrating research education into the residency curriculum can help trainees develop the necessary skills for conducting high-quality research. This may include workshops on research methodology, biostatistics, and scientific writing. Second, providing protected time for research during residency can allow trainees to focus on their projects without compromising clinical responsibilities. Third, fostering a culture of mentorship by pairing residents with experienced researchers can offer valuable guidance and support. Institutions should also prioritize access to research resources such as funding, data analysis software, and robust research infrastructure. Finally, emphasizing the importance of research productivity during medical school undergraduate training and encouraging early involvement in scholarly activities can prepare future residents for successful and stranger research engagement. It was found that publication count in preresidency was a greater predictor of future research productivity in the US.[15] In Canada, research productivity before residency has been linked to a greater advancement in research development.[14] These initiatives, combined with a strong focus on awards and grants, can collectively enhance the overall research output of ophthalmology training programs and better equip trainees for academic and clinical careers.

The current study has a few limitations. Metrics such as the number of publications, citations, and h-index may not fully capture the quality or impact of research contributions. The h-index does not account for the quality or study design of each paper, includes self-citations, and often underrepresents the scholarly contributions of early-career researchers.[16] In addition, the study did not examine other forms of scholarly activities, such as conference paper presentations, book and chapter publications, or other nonpeer-reviewed contributions. Variations in how research is funded and supported across regions and programs were not fully considered, which may influence the interpretation of results. However, using the current study as a baseline for comparison, a longitudinal study should be conducted following the implementation of strategies to enhance the research curriculum. Future studies could also explore preresidency characteristics, such as licensing examiation scores and grade point average, and their association with research productivity.

CONCLUSION

This study highlights the significant variability in research productivity among ophthalmology residents in Saudi Arabia among different programs. Factors such as residency training programs, fellowship enrollment and/or subspecialty choice, and academic appointments have influenced research output. Residents from institutions with stronger research infrastructures and those who pursued fellowship training demonstrated higher productivity in terms of publications, citations, and h-index. Fellowship subspecialties such as oculoplastic surgery and cornea were associated with the highest levels of research activity. These findings can help future trainees navigate their career pathways, providing insights into the impact of fellowship choices and academic roles on research success. In addition, ophthalmology academic leaders can use this data to better understand the current research landscape among trainees and identify areas for improvement and future planning.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.