Academic Background of Irish Orthopaedic Trainees

M. Nugent
Galway University Hospitals, Dept. of Orthopaedic Surgery, Merlin Park Hospital, Galway, Ireland

Abstract

Introduction
Academic achievement may be used to distinguish between trainees in competition for training or consultant posts. This study aimed to quantify the academic achievement among orthopaedic trainees in Ireland.
Methods

A web-based questionnaire was distributed to all trainees on the Irish Trauma and Orthopaedics specialist training programme. Questions included current year of training and attainment of higher degrees, publications, grants and prizes.
Results

Thirty-eight of 51 trainees completed the questionnaire (74%). All had commenced or completed a higher degree, more frequently a taught programme among ST3 and ST4 trainees and research based among the more senior years. Thirty-five (69%) had at least one peer-reviewed publication at the time of appointment. All continued some research activity. A majority aspire to a predominantly clinical career.
Discussion
Levels of academic achievement remain high among Irish orthopaedic trainees. Although junior trainees have fewer publications at appointment, all continue research on the training programme.

Introduction

Academic achievement in the form of higher degrees and peer-reviewed publications may be used as a means of distinguishing between candidates in selection for training programmes and ultimately consultant posts. These academic achievements are often more easily quantified and compared than other factors in the decision-making process. Anecdotally there is significant variation between candidates within a given specialty and between specialties, however recently published studies suggest a general increase in publication productivity over time for a number of surgical specialties.1-4 Many studies have investigated the publication rates, predictors of a podium presentation being accepted for publication and time to publication of oral and poster presentations made at a variety of scientific meetings and conferences, both orthopaedic and non-orthopaedic.5-11 Others have considered the levels of evidence of free papers presented in scientific meetings.12 While these studies may be useful adjuncts in assessing the quality of research performed, they do not necessarily provide an indication of the level of activity of the typical trainee.

Within the last decade there have been published studies investigating the academic achievements and future career aspirations of British and Irish specialist trainees in both oral and maxillofacial surgery (OMFS) and in radiology.13,14 An older study attempted to quantify the academic achievements and publication rate of plastic surgery trainees at a more junior level (senior house officers).15 However, there are currently no published studies that quantify the academic achievements of Irish orthopaedic trainees. In addition, the surgical training pathway has undergone significant changes in recent years across all subspecialties. One effect of these changes is a reduction in the total amount of time in training and appointment of some trainees to the specialist training programme at a relatively earlier stage in their careers compared to their predecessors. It is not yet clear what impact, if any, this shorter time in training may have on academic outputs of trainees. Greater clarity in this area may be helpful to both trainees and consultants alike. This study aimed to quantify the level of academic achievement among current orthopaedic specialist trainees in Ireland and establish their longer term career aspirations with regard to clinical or academic roles.

Methods

A ten-item web-based questionnaire was created on http://surveymonkey.com and a link distributed via email list to all trainees on the Irish Trauma and Orthopaedics specialist training programme. A reminder was sent one week after the initial mailing. The questionnaire content is shown in full in appendix 1. It included the current year of training and a number of questions pertaining to any higher degrees, publications, grants and prizes attained. No identifying information was requested.

Results

The questionnaire was distributed to 51 trainees and completed by 38, giving an overall response rate of 74%. All six years of training were represented although there was a greater response rate from the more junior years. There are also more trainees in years 1 and 2 (ST3 and ST4) than the more senior years.

 Thirty-five (92%) respondents had completed a higher degree and of the remaining three, one had submitted a thesis and the other two reported a higher degree in progress. The type of higher degree awarded varied but the most common was a masters in surgery (MCh) with 17 (49%) holding a taught MCh and 7 (20%) holding a MCh by research. Nine (26%) respondents had doctorates (7 MDs and 2 PhDs) while 2 (6%) held other masters qualifications. There was a marked preponderance of taught masters qualifications among the year 1 and year 2 trainees, compared to greater numbers of research based awards among those in the more senior years. Of the 17 taught MCh qualifications, 15 were held by trainees in years 1 to 3 (ST3 to ST5) while only 2 were held by trainees in years 4 to 6 (ST6 to ST8). The respondents with higher degrees in progress were both year 1 (ST3) trainees.

Most trainees had at least one peer-reviewed publication at the time of appointment to the training programme. Only 3 respondents (8%) had no publications at this stage. Over one third (13 respondents) had between 3 and 5 publications, however there was a broad spread in the responses to this question. Two respondents (5%) had more than 10 publications at the time of appointment. Figure 1 illustrates the numbers of publications among trainees at the time of appointment stratified by year of training. It can be seen from this that a majority of trainees in years 1 and 2 had between 1 and 5 publications at the time of appointment while most of those in years 3 to 6 had between 3 and 10 publications at appointment.

Trainees were also asked how many publications they had had either published or accepted since commencing the training programme. These responses are summarized in table 1. Figure 2 shows the number of publications while on the programme according to the year in training. As expected, these numbers are typically higher for those who have been on the programme for a greater duration.

Most respondents had some research projects currently in progress, as detailed in table 2. Twenty eight respondents (66%) had won a prize for research or academic achievement – more than half for oral research presentations. Some had won more than one prize. Only 13 respondents had ever submitted a research grant application, with 8 of these having sucessfully obtained a grant. Twenty six (68%) respondents thought that they had had adequate senior support for research projects since commencing the training programme.

Twenty five (66%) respondents aspire to a future career that is predominantly clinical while the remainder are aiming for a part academic, part clinical career. Nobody reported a predominantly academic career as a long term aspiration.

Discussion

Ongoing research and academic output is now considered an integral aspect of many surgical careers. It is generally accepted that this contributes to a broadening of the available evidence base for clinical practice, although pressure to publish may lead to a greater emphasis on quantity rather than quality of published papers. Indeed, one recent UK study suggests that there may be some correlation between academic output and better mortality rates in NHS trusts.16 In addition, some minimum research output is required to attain a certificate of completion of training in Ireland and the UK and this is supported by trainees represented by the Association of Surgeons in Training (ASiT).17

The present study helps to quantify the level of academic achievement and research outputs among Irish orthopaedic trainees. Previous work published in Ireland has assessed both publication productivity in terms of publication numbers and impact factors of these for individual consultants and hospital units over a five year period.18 A subsequent study combined productivity from the individual units to identify the combination of rotations most likely to generate maximum numbers of publications for trainees as they progress through the programme.19 While the combinations of rotations in the training programme has since changed, both of these studies still provide very useful information for trainees, particularly those in the early stages of their careers. However this is the first study to investigate the academic achievements of individual trainees and provides an indication of both the standards required to attain a place on the training programme and the typical output following appointment.

The question about having commenced or completed a higher degree yielded some interesting findings. While all respondents had either commenced or completed a higher degree, there was quite marked variation among different years of training in the type of degree awarded. The majority of those undertaking taught masters programmes were in their first two years of training while those in the more senior years were more likely to have completed research based programmes. This is not an entirely unexpected finding, as those in the new accelerated ‘run through’ training programme constitute over half of the trainees in the first two years of training. This reflects a change in the core surgical training programme structure introduced four years ago, followed by direct progression to specialist training for sucessful candidates. These trainees typically complete a taught masters programme on a part time basis while many of the older trainees would have taken time out between basic surgical training and higher surgical training to undertake a research based thesis. It is likely given the new structure of surgical training programmes in Ireland that more trainees going forward will choose the route of the part-time taught masters to attain a higher degree qualification. Therefore it is vital that the available programmes are based on relevant and useful content.

All except three respondents had at least one peer-reviewed publication at the time of appointment to the programme. Indeed, this may be largely due to the selection criteria for entry to the training programme where points are awarded for publication - hence in practical terms it has traditionally been very difficult to glean sufficient points elsewhere to remain a competitive candidate without any publications. An interesting finding in this study is that those trainees in the first two years of the training programme tended to have fewer publications at the time of appointment than their predecessors (as shown in figure 2). This is also likely to be related to the new training structure as trainees on the ‘run through’ programme have less time prior to appointment in which they can generate research leading to publication. In addition, research based theses may yield more publications than a taught masters programme. The number of publications produced while on the training programme appears to be broadly associated with the duration of time on the programme (as expected), suggesting that the younger trainees who start with fewer publications still have a similar rate of productivity once appointed.

The main limitations of the present study are that it encompasses a relatively small number of trainees and does not take into account the quality of the publications (for example according to criteria such as impact factor or citations). This has been shown elsewhere to be widely variable among orthopaedic surgeons.20 However it does still provide significant information on current levels of academic achievement. This is useful both for trainees embarking on an orthopaedic career and for trainers involved in selection processes and assessment of trainees.

These results suggest that standards of academic achievement among orthopaedic trainees remain high overall however further evaluation of the quality of research produced may be useful.

Conflict of Interest
None declared.

Corresponding Author
Mary Nugent,
Galway University Hospitals,
Dept. of Orthopaedic Surgery,
Merlin Park Hospital,
Galway,
Ireland
Email: nugentmary@gmail.com
Telephone:+353857201799

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