259seek funding from other external sources forcing a highly competitive application
process with most external funding opportunities.
Lack of institutional support from administration and/or faculty is another limi-
tation. Few things are more frustrating to a student or resident, than to be given
couple sentences of a research concept and left on their own to complete said project
only to then be asked months later where the completed manuscript is. Another dif-
ficulty with faculty is the potential to delay progression of the study, especially in
the manuscript phase, due to a hectic schedule. Residents and medical students also
want to see studies come to an end in order to provide the all-important outcome of
the research project which will help them to fulfill requirements or become more
competitive candidates of residency and fellowship.
The biggest limitation to conducting research with residents and medical
students is time. Residents and medical students have already strained schedules
filled with classes, clinical rotations, call, and, in the case of surgery, procedures
that fill their days, nights, and some weekends. On top of that, residents are limited
in the amount of hours they are allowed to work, and both students and residents
must continue to study in preparation for USMLE and in-service exams. Some
programs offer research electives for students and designated research-only rota-
tions for residents (1–2 months). There are research internships available to medi-
cal students, most commonly between their first and second years, which allow for
a 4–8-week exposure to research ranging from benchtop research to translational
exposure [ 25 , 26 ]. The problem with the vast majority of research projects is that
they cannot be accomplished in a 1–2-month time frame. Even these summer
research internship programs acknowledge in their application process that this
short time may not be enough to complete a project. Sometimes the IRB process
can alone take multiple months to complete before final approval is obtained.
Research Infrastructure
Although the ACGME focus has shifted from structure and process to scholarly
activity outcomes (i.e., abstracts, presentations, publications), structure and process
have to be in place to facilitate the outcomes as does committed mentorship and
consistent oversight. The most productive outcomes will come when a multi-tiered
team is in place to help residents and medical students in their research endeavors.
This research infrastructure should consist of faculty (both clinical and basic), stat-
isticians (if available), and dedicated research personnel.
Faculty
At most institutions and IRBs, no resident or medical student can conduct research
without direct involvement with at least one faculty member. The difficulty lies in
identifying highly involved faculty that are not only productive with research but are
willing to devote time to guiding medical students and residents throughout the
entire process of the research project. Faculty should engage residents and students
and make themselves available for meetings and clarifications.
15 Optimizing Research in Surgical Residents and Medical Students