The Rising Challenge of Training Physician-Scientists: Recommendations From a Canadian National Consensus Conference

Pushing the Boundaries for Evidenced-Based Practice: Can Online Training Enhance Andrology Research Capacity Worldwide? An Exploration of the Barriers and Enablers - The Global Andrology Forum

PURPOSE

This is the first study to design and assess a research capacity building (RCB) specifically tailored for clinical and non-clinical andrology practitioners worldwide. We appraised: 1) the barriers and enablers to research among these practitioners; 2) attendees' satisfaction with the webinar; and 3) research knowledge acquisition as a result of the webinar (before/after quiz).

MATERIALS AND METHODS

A online RCB webinar was designed, comprising two presentations in research design and systematic review/meta-analysis (SR/MA). An online survey using validated published questionnaires assessed the three above-stated objectives. Paired t-test compared the means of the pre- and post-webinar scores. Subgroup analysis was performed on the participants' professional background, sex, and number of years in practice.

RESULTS

A total of 237 participants attended the webinar, of which 184 completed the survey and are included in the current analysis. Male participants were about double the females and 60.9% were from Asian countries. The most common research enablers were to publish scientific papers (14.8%) and to develop research (14.7%) or new skills (12.7%). The most common barriers were the lack of training in research (12.4%), training in research software (11.8%), and time for research (11.8%). Satisfaction with the webinar was considerably high (86.3%-88.4%) for the different features of the webinar. Compared to the pre-webinar knowledge level, there were significant improvements in participants' research knowledge acquisition after the webinar in terms of the total score for the quiz (13.7±4.31 vs. 21.5±4.7), as well as the scores for the study design (7.12±2.37 vs. 11.5±2.69) and SR/MA sessions (6.63±2.63 vs. 9.93±2.49) (p<0.001 for each).

CONCLUSIONS

Clinical and non-clinical andrology webinar attendees recognized the importance of research and exhibited a range of research skills, knowledge and experience. There were significant improvements in the participants' knowledge and understanding of the components of scientific research. We propose an RCB model that can be implemented and further modeled by organizations with similar academic research goals.

"Walking on both sides of the fence": A qualitative exploration of the challenges and opportunities facing emergent clinician-scientists in child health

RATIONALE, AIMS, AND OBJECTIVES

While paediatric clinician-scientists are ideally positioned to generate clinically relevant research and translate research evidence into practice, they face challenges in this dual role. The authors sought to explore the unique contributions, opportunities, and challenges of paediatric clinician-scientists, including issues related to training and ongoing support needs to ensure their success.

METHOD

The authors used a qualitative descriptive approach with thematic analysis to explore the experiences of clinician-scientist stakeholders in child health (n = 39). Semi-structured interviews (60 min) were conducted virtually and recorded. Thematic analysis was conducted according to the phases outlined by Braun and Clarke (2006).

RESULTS

The analysis resulted in the creation of three themes: (1) "Walking on both sides of the fence": unique positioning of clinician-scientists for advancing clinical practice and research; (2) the clinician-scientist: a specialized role with significant challenges; and (3) beyond the basics of clinical and research training programmes: essential skill sets and knowledge for future clinician-scientists.

CONCLUSIONS

While clinician-scientists can make unique contributions to the advancement of evidence-based practice, they face significant barriers straddling their dual roles including divergent institutional cultures in healthcare and academia and a lack of infrastructure to effectively support clinician-scientist positions. Training programmes can play an important role in mentoring and supporting early-career clinician-scientists.

A Fully Online Research Practicum Curriculum for Undergraduate Medical Students: A Protocol Paper

INTRODUCTION

Research is a critically important skill for medical trainees that helps physicians to advance the state of science and provide optimal healthcare to patients. The number of physician-scientists is decreasing. Competing priorities, limited research faculty, shrinking research budgets, and meeting accreditation standards limit the amount of time and effort needed to train undergraduate medical students sufficiently for them to engage in independent research activities. The purpose of this paper is to describe the development and implementation of a fully online research practicum as part of the medical school curriculum.

METHODS

A fully online research curriculum for preclinical medical students was developed and implemented by the researchers as a mandatory component of student training. This curriculum addressed research education challenges in medical schools with limited resources and/or for situations for which face-to-face research may be impractical or expensive. Students were also encouraged to practice critical thinking and critical appraisal of the evidence. Student-initiated research projects were conducted in teams and completed with support from faculty research mentors and librarians. During the first two cycles, 86 student team projects were completed. During the third cycle, 45 team projects were conducted.

RESULTS

Two complete cycles of a two-semester research practicum were completed. The majority of these studies were presented at regional, national, and international conferences, published as posters, and/or published as articles in peer-reviewed journals. Faculty mentor publications also increased as a result of engagement in the practicum.

DISCUSSION

The results of this research practicum provide evidence of the usefulness of a hands-on tailored research program delivered online for increasing research literacy, promoting interest among medical students in research, and motivation for future engagement in research as verified by student project outcomes during and beyond the practicum experience. The practicum can be used for individual students or as a team-based approach. A research practicum such as this also has the potential to improve the prospects of a successful application for post-graduate training, grants, and high-impact publications.

A global view of the aspiring physician-scientist

Physician-scientists have epitomized the blending of deep, rigorous impactful curiosity with broad attention to human health for centuries. While we aspire to prepare all physicians with an appreciation for these skills, those who apply them to push the understanding of the boundaries of human physiology and disease, to advance treatments, and to increase our knowledge base in the arena of human health can fulfill an essential space for our society, economies, and overall well-being. Working arm in arm with basic and translational scientists as well as expert clinicians, as peers in both groups, this career additionally serves as a bridge to facilitate the pace and direction of research that ultimately impacts health. Globally, there are remarkable similarities in challenges in this career path, and in the approaches employed to overcome them. Herein, we review how different countries train physician-scientists and suggest strategies to further bolster this career path.

Early Outcomes of a New NIH Program to Support Research in Residency

The work of physician-investigators has historically led to key discoveries and developments in modern medicine, but recent decades have seen significant declines in the number of U.S. physician-investigators. One of the barriers to physicians participating in research is the lack of mentored research opportunities during clinical training, especially during residency training. In response to this identified barrier and to expand the physician-investigator workforce, the National Institutes of Health initiated the R38 program, known as Stimulating Access to Research in Residency, to support mentored research opportunities for residents. This article reports on the early outcomes of the recipients of the initial round of R38 awards, granted in 2018. Early positive outcomes include increases in the reported likelihood of resident-investigators pursuing physician-investigator careers, greater reported clarity in resident-investigators' research directions, the commitment of additional institutional resources to support the R38-awarded programs, and the approval of resident-investigators as having met training requirements for certification by multiple medical boards.

Curricula, Teaching Methods, and Success Metrics of Clinician-Scientist Training Programs: A Scoping Review

PURPOSE

To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models.

METHOD

The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics.

RESULTS

From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment).

CONCLUSIONS

Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.

A Novel Curricular Framework to Develop Grant Writing Skills among MD-PhD Students

Background/Objectives:

Physician-scientists have long been in high demand owing to their role as key drivers of biomedical innovation, but their dwindling prevalence in research and medical communities threatens ongoing progress. As the principal avenue for physician-scientist development, combined MD–PhD training programs and NIH-funded Medical Scientist Training Programs (MSTPs) must address all aspects of career development, including grant writing skills.

Methods:

The NIH F-series grants – the F30 grant in particular – model the NIH format of federal funding, and are thus ideal opportunities to acquire biomedical research grant preparation experience. Therefore, in this report, we describe a curricular model through which predoctoral MSTP students obtain exposure to – and training for – F-series grant conceptualization, writing, and evaluation.

Results:

Since the development of these longitudinal courses, we observed trending improvements in student funding success rates, particularly among original submissions, and perceived benefits among participating students.

Physician-scientists in the United States at 2020: Trends and concerns

Physician‐scientists comprise a unique and valuable part of the biomedical workforce, but for decades there has been concern about the number of physicians actively engaged in research. Reports have outlined the challenges facing physician‐scientists, and programs have been initiated to encourage and facilitate research careers for medically trained scientists. Many of these initiatives have demonstrated successful outcomes, but there has not been a recent summary of the impact of the past decade of effort. This report compiles available data from surveys of medical education and physician research participation to assess changes in the physician‐scientist workforce from 2011–2020. Several trends are positive: rising enrollments in MD‐PhD programs, greater levels of interest in research careers among matriculating medical students, more research experience during medical school and rising numbers of physicians in academic medicine, and an increase in first R01 grants to physician‐scientists. However, there are now decreased levels of interest in research careers among graduating medical students, a steady decline in MDs applying for NIH loan repayment program support, an increased age at first R01 grant success for physicians, and fewer physicians reporting research as their primary work activity: all of these indicators create concern for the stability of the career path. Despite a recommendation by the Physician‐Scientist Workforce in 2014 to create “real‐time” reporting on NIH grants and grantees to help the public assess trends, this initiative has not been completed. Better information is still needed to fully understand the status of the physician‐scientist workforce, and to assess efforts to stabilize this vulnerable career path.

Facilitating Success of the Early Stage Surgeon Scientist Trainee: Growing the Surgeon Scientist Pipeline

OBJECTIVE

Surgeon scientists bring to bear highly specialized talent and innovative and impactful solutions for complicated clinical problems. Our objective is to inform and provide framework for early stage surgeon scientist training and support.

SUMMARY OF BACKGROUND DATA

Undergraduate, medical student, and residency experiences impact the career trajectory of surgeon scientists. To combat the attrition of the surgeon scientist pipeline, interventions are needed to engage trainees and to increase the likelihood of success of future surgeon scientists.

METHODS

A surgery resident writing group at an academic medical center, with guidance from faculty, prepared this guidance document for early stage surgeon scientist trainees with integration of the published literature to provide context. The publicly available National Institutes of Health RePORTER tool was queried to provide data salient to early stage surgeon scientist training.

RESULTS

The educational path of surgeons and the potential research career entry points are outlined. Challenges and critical supportive elements needed to inspire and sustain progress along the surgeon scientist training path are detailed. Funding mechanisms available to support formal scientific training of early stage surgeon scientists are identified and obstacles specific to surgical careers are discussed.

CONCLUSIONS

This guidance enhances awareness of essential education, communication, infrastructure, resources, and advocacy by surgery leaders and other stakeholders to promote quality research training in residency and to re-invigorate the surgeon scientist pipeline.

Ten years of NIHR research training: perceptions of the programmes: a qualitative interview study

OBJECTIVES

The UK National Institute for Health Research (NIHR) training programmes were created to build and sustain research capacity in healthcare. Following the training programme 10-year strategic review, this qualitative study aimed to deepen understanding of facilitators and barriers for those progressing through NIHR-supported research careers.

DESIGN

Semistructured qualitative study.

DATA COLLECTION AND ANALYSIS

Telephone interviews conducted between May and August 2017 were digitally recorded, transcribed and analysed using Framework Approach.

SETTING

UK National Health Service (NHS) Trusts, university medical schools, District General Hospitals, Integrated Academic Training Programme centres and Research Design Services across the North East, North West, South East and South West of England, London and the Midlands.

PARTICIPANTS

Fourteen women and eight men, of whom, 14 were previous or current NIHR personal awardees (seven doctors and seven allied health professionals (AHPs) or nurses) and eight were managers (staff within clinical or university training-related roles).

RESULTS

(1) NIHR awards were viewed as transformative for research careers; (2) however, there were perceptions of a biased 'playing field'. (3) Inequalities were perceived for AHPs and nurses, those outside of established research institutes and those in 'unfashionable' specialisms. (4) While support for NIHR awards contributed to a healthy research culture, (5) short-term awards were perceived as a barrier to continuing an independent research career.

CONCLUSIONS

Participants perceived many strengths of the NIHR training programmes in terms of developing individual careers and research capacity. Areas in which improvement could enhance the ability to attract, develop and retain researcher were identified. Our findings are of relevance to schemes in other countries, where healthcare researchers experience similar challenges. Further work is needed to overcome barriers and ensure equity of access to, and success within, clinical research training schemes to sustain the research workforce needed to address future global health challenges.

Influence of national culture on mentoring relationship: a qualitative study of Japanese physician-scientists

BACKGROUND

Nurturing of physician-scientists is an important mission of academic medical institutes. Although the importance of mentorship in developing future physician-scientists internationally is well established, not much information is available about how they are mentored and how national cultures influence the mentoring relationship. This study explores the cultural characteristics of mentoring relationships between senior mentors and junior mentees of Japanese physician-scientists.

METHOD

A qualitative approach has been employed to explore mentoring relationships of Japanese physician-scientists from cultural viewpoints, through semi-structured interviews with 17 mentees who had the experience of working overseas as post-doctoral research fellow. The reflection of their experiences and the perception of mentoring relationships before going abroad were thematically analyzed by applying Hofstede's model of six cultural dimensions as a theoretical framework.

RESULTS

Twelve characteristic themes for mentoring were observed, including trustworthy dependency on mentor, embracing paternalistic mentoring, mentee's initiative within expectations of mentor based on power distance, a sense of loyalty to mentor/organization/colleagues, family-like relationship with mentor based on collectivism, sense of security on being led by mentor through uncertainty avoidance, motivation by role modeling for the competitive academic world, and adaption of female mentee/mentor to a male-dominated academic structure based on masculinity, a long-term relationship between mentor and mentee, receiving advice for organizational continuity based on long-term orientation, putting work before leisure, and friendly relationship between mentor and mentee outside of work based on indulgence.

CONCLUSIONS

This study identified the characteristic mentoring relationships of postgraduate mentees of Japanese physician-scientists. Considering the importance of mentoring for physician-scientists in a globalized society, understanding the characteristics of national cultures would help in ensuring culture-sensitive mentoring and would contribute to the development of academic medicine.

Why scientists, academic institutions, and investors fail in bringing more products to the bedside: the Active Compass model for overcoming the innovation paradox

The vast majority of good science and excellent ideas do not translate into products. Many good products that have the potential to assist in diagnosis and therapy do not mature into everyday care. This often becomes a source of frustration for innovators, academic institutions, companies both small and large, and investors. The "innovation paradox" , wherein excellent ideas and good science fail to reach the bedside, is a major challenge. This study presents the Active Compass model as a way to overcome this obstacle. The model is designed to assist projects at early stages by redirecting and reshaping them in a way that increases their chances of reaching the markets. The model is based on the use of next-generation translational research and on creating differentiators at the early stages of development. The proposed model's implementation by innovators, scientists, technology transfer offices, academic institutions, analysts, and investors can help move forward high-potential projects to improve the quality of life and alleviate the burdens of disease.

Is It Possible for Registered Nurses and Physicians to Combine Research and Clinical Work to Facilitate Evidence-Based Practice?

BACKGROUND

Evidence-based patient care requires clinicians to make decisions based on the best available evidence and researchers to provide new scientific knowledge. Clinician-scientists (i.e., registered nurses [RNs] and physicians with a PhD) make important contributions to health care; yet, their roles are not fully understood, supported, or recognized by healthcare leaders. Only a few studies have addressed the factors that enable RNs and physicians to simultaneously pursue both clinical work and research after earning a PhD.

AIM

To explore what factors have a bearing on the ability of RNs and physicians to pursue research and clinical work simultaneously after earning a PhD.

METHODS

The study used a qualitative design based on open-ended, in-depth interviews. Data were analyzed using conventional content analysis.

RESULTS

Analysis of the data yielded a broad range of factors that RNs and physicians perceived to either facilitate or hinder continued research while simultaneously undertaking clinical work. Most of the perceived barriers were due to factors external to the individual. Several factors applied to both professions yet differed in impact. Factors mentioned as fundamental to continued research were financial support and allocated time for research. Maintenance of a good relationship with academia and support from management were also considered to be important. In addition, personal factors, such as motivation to pursue a research career after obtaining a PhD, were influential.

LINKING EVIDENCE TO ACTION

A supportive infrastructure is important for enabling clinician-scientists to pursue research after earning a PhD. Creating favorable conditions for RNs and physicians to combine research with clinical work can facilitate evidence-based practice. This information can be used for interventions aimed at improving the conditions for clinician-scientists.

Impact of a Respiratory Disease Young Investigators' Forum on the Career Development of Physician-Scientists

Background: To reverse the dramatic decline in the U.S. physician-scientist workforce, interventions are necessary to retain physicians in research careers.

Objective: To evaluate the impact of an annual 3-day symposium, the Respiratory Disease Young Investigators' Forum (RDYIF), designed to guide fellows and junior faculty into successful physician-scientist careers.

Methods: In this retrospective, observational study, a questionnaire was e-mailed to 308 physicians who participated in the RDYIF between 2005 and 2018. The questionnaire was administered by National Jewish Health study personnel in the spring of 2019. Responses were primarily analyzed using descriptive and qualitative approaches.

Results: The response rate was 39.3% (n = 121), with 107 of responders (88.4%) completing the full survey. The majority of survey completers currently worked as physician-scientists (76.6%; n = 82), held faculty positions (88.8%; n = 95) in an academic center (90.6%; n = 97), and were currently involved in research (93.4%; n = 100). The majority had been an author on ≥10 peer-reviewed publications (61.3%, n = 65) and had been awarded research grants (71.7%; n = 76). Thirty completers (28.3%) had served as a principal investigator on one or more clinical trials. Completers indicated that participation in the RDYIF had a "strong impact" or "very strong impact" on their career development as physician-scientists.

Conclusion: Participation in the RDYIF strengthened participants' interest in physician-scientist careers and appeared to track with successful career development. Young Investigator Forums such as the RDYIF may be an effective intervention to support the declining supply of physician-scientists in North America.

Critical Gaps in Understanding the Clinician-Scientist Workforce: Results of an International Expert Meeting

Clinician-scientists-health care professionals expert in research and clinical practice-can play a vital role in translating research outcomes to clinical practice. Concerns about the sustainability of the clinician-scientist workforce have been expressed in the literature for decades. Although many have made recommendations to increase the clinician-scientist workforce, there has been no substantial change. Therefore, an international expert meeting was held in March 2017 in Utrecht, the Netherlands, with the goal of discovering unidentified gaps in our understanding of challenges to the sustainability of the clinician-scientist workforce. Nineteen individuals (steering committee members; representatives from the AAMC, AFMC, and RCPSC; and physician-scientists, nurse-scientists, education scientists, deans, vice deans, undergraduate and postgraduate program directors, and a medical student) from Canada, the Netherlands, the United States, and Singapore participated in the meeting. The meeting identified 3 critical questions to be addressed: (1) What is the particular nature of the clinician-scientist role? (2) How are clinician-scientists to be recognized within the health and health research ecosystem? and (3) How can the value that clinician-scientists add to translational medicine and research be clarified to stakeholders and the public? The meeting participants identified a 3-fold agenda to address these questions: articulating the value proposition of clinician-scientists, supporting professionalization and professional identity development, and integrating clinical and research training. Addressing the 3 critical questions will likely contribute to a wider recognition of the value of clinician-scientists and be a first step in advancing from recommendations toward system-level changes to reinvigorate the clinician-scientist workforce.

Exploring medically-related Canadian summer student research programs: a National Cross-sectional Survey Study

BACKGROUND

Summer student research programs (SSRPs) serve to generate student interest in research and a clinician-scientist career path. This study sought to understand the composition of existing medically-related Canadian SSRPs, describe the current selection, education and evaluation practices and highlight opportunities for improvement.

METHODS

A cross-sectional survey study among English-language-based medically-related Canadian SSRPs for undergraduate and medical students was conducted. Programs were systematically identified through academic and/or institutional websites. The survey, administered between June-August 2016, collected information on program demographics, competition, selection, student experience, and program self-evaluation.

RESULTS

Forty-six of 91 (50.5%) identified programs responded. These SSRPs collectively offered 1842 positions with a mean 3.76 applicants per placement. Most programs (78.3%, n = 36/46) required students to independently secure a research supervisor. A formal curriculum existed among 61.4% (n = 27/44) of programs. Few programs (5.9%, n = 2/34) offered an integrated clinical observership. Regarding evaluation, 11.4% (n = 5/44) of programs tracked subsequent research productivity and 27.5% (n = 11/40) conducted long-term impact assessments.

CONCLUSIONS

Canadian SSRPs are highly competitive with the responsibility of selection primarily with the individual research supervisor rather than a centralized committee. Most programs offered students opportunities to develop both research and communication skills. Presently, the majority of programs do not have a sufficient evaluation component. These findings indicate that SSRPs may benefit from refinement of selection processes and more robust evaluation of their utility. To address this challenge, the authors describe a logic model that provides a set of core outcomes which can be applied as a framework to guide program evaluation of SSRPs.

Facilitators and barriers to brokering between research and care by senior clinical-scientists in general practice and elderly care medicine

BACKGROUND

Clinician-scientists (CSs) are physicians who work in daily care and have an academic role in research or education. They may act as knowledge brokers and help to connect research and clinical practice. There is no data available on CSs' brokering activities and the perceived barriers and facilitators to optimising their role in general practice (GP) and elderly care medicine (EM).

AIM

To identify the brokering activities of CSs in these fields and the barriers and facilitators they come across whilst sharing knowledge and connecting people in research and frontline health care.

DESIGN AND SETTING

Qualitative interview study among 17 Dutch senior CSs.

METHOD

Interview data were audio recorded, transcribed verbatim and thematic interpretative analysis was used to identify themes.

RESULTS

CSs facilitate collaboration between researchers and practitioners. They exchange knowledge on both sides, make use of extensive networks and constantly and actively involve care in research and research in care. CSs come across barriers as well as facilitators that influence their brokering activities. Some barriers and facilitators are at the individual level, other are related more to the job context and workplace.

CONCLUSIONS

This study reveals barriers to overcome and facilitators to develop related to the brokering role of CSs. To make the best use of CSs, brokering activities and the added value of CSs should be recognised and supported. Awareness of what CSs need to function effectively in demanding work settings could be important for the future impact of the role on the fields of GP and EM.

Preventing Translational Scientists From Extinction: The Long-Term Impact of a Personalized Training Program in Translational Medicine on the Careers of Translational Scientists

Far too much biomedical research is wasted and ends in the so called "Valley of Death": the gap that exists between biomedical research and its clinical application. While the translational process requires collaboration between many disciplines, current translational medicine focuses on single disciplines. Therefore, educational pathways that integrate clinical and research skills in interdisciplinary and interprofessional contexts are needed. The Eureka institute (http://www.eurekainstitute.org/) was founded to address these issues. The institute organizes an annual 1-week international certificate course to educate professionals in the domains of translational medicine. Study design: This study set out to investigate the impact of the Eureka certificate course on the alumni, focusing on their ability to engage in translational activities and thus become more proficient translational professionals. An explanatory, mixed-methods study was executed. Data collection: A questionnaire was distributed to collect quantitative data on the number of alumni who were able to apply what they learned during the Eureka course and engage in translational activities. Questionnaire data were also used to inform the semi-structured interviews that were conducted subsequently. Results: Fifty-one percent of the alumni reported that participating in the Eureka course played a role in their decision to change to a different job or in the way they were accomplishing their everyday work. Ten conditions for change that either hampered or supported the Eureka alumni's engagement in translational research activities were identified. Further, the learning outcomes of the Eureka course that impacted the alumni's professional activities were explored using Personal Professional Theory (PPT). The insight that alumni gained in the full translational spectrum and stakeholders involved stimulated reflection on their own role within that pathway. Further, according to the alumni, the course provided them with the skills and confidence to pursue a career as translational professional. These learning outcomes, in combination with conditions that supported alumni's engagement in translational activities, such as supportive professional partners, opportunities to network or collaborate, and a translational work environment, contributed to the large number of alumni that were able to engage in translational activities.

Physician-Scientist Careers in the Biotechnology and Pharmaceutical Industries

Many careers are open to physician-scientists in the biotechnology and pharmaceutical sectors. However, research is structured very differently in these environments compared to academic medicine. This article highlights these differences and the reasons for them, then outlines the different career paths available to physician-scientists in the variegated worlds of biotechnology and pharmaceutical companies.

Research methodology: how to maximize your research potential

Scientific education and a clinical background allow orthopaedic surgeons to perform leading research. Several resources, skills and techniques may be developed to maximize their research potential.Surgeon-researchers should develop Specific, Measurable, Achievable, Realistic, and Time-defined (SMART) goals. It is critical to define a timeline - which can be 1 year, 3 years, 5 years - to re-evaluate goals and to plan and identify potential obstacles.Physician-scientists are a product of training, funding, resources, practice setting, context, environment, and infrastructure. Although orthopaedic surgery has difficulty in recruiting surgeon-scientists, these are essential for the promotion of advances in technologies and treatment, as they have unique abilities to raise questions from the bedside and the operating room.The most critical personal traits necessary to succeed as a surgeon-scientist are persistence, resilience, and passion for research. These traits may be innate or acquired through mentorship and from role models.Mentors can improve mentees' research efficiency and help them to persevere.Clinical researchers and surgeon-scientists should focus their research interests and efforts in their areas of clinical expertise.For surgeon-researchers to succeed they must have passion for research, persistence in working toward a goal, collaboration/teamwork skills, resilience, research training/experience, a track record of publications, clear goals and expectations, and a defined research plan as well as being clinically excellent. A formal research degree is desirable.Having non-clinician scientists in the team brings added expertise and value.Funding and protected research time are important. To provide outstanding clinical care and improve the quality of the care delivered, surgeons must be leaders in innovation and research. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170065.