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research. Metaphorically, new faculty can be seen as driving a tricycle with each wheel corresponding to one aspect of the academic mission including patient care, education, and research. In an ideal world, each wheel would be the same size, but in reality both education and research are frequently much smaller than the front wheel representing patient care. This chapter focuses on describing basic tools required to inflate the rear tires and can help create a pathway for many academicians to enhance their full academic mission and still satisfy their growing clinical responsibilities.

What Is Evidence-Based Medicine?

Discussion of evidence-based medicine (EBM) now permeates the medical field. All clinical practices should be guided by the results of EBM, with clinical interventions being based on results obtained from good clinical studies. The EBM framework is useful for evaluating the quality of clinical studies, which traditionally have focused on treatment efficacy, the accuracy of diagnostic tests, clinical guidelines, and prognosis and risk. EBM comes in different forms, the highest being systematic reviews and meta-analyses, and these can provide big-picture answers to clinical questions when the individual results of studies seem to conflict. Lower forms of EBM include observational studies and clinical trials, and even lower forms include case series and expert opinion.

EBM obviously cannot exist without the “evidence” in the form of various published research studies. Surgical research can be viewed in terms of the type of evidence it generates and how that evidence can be used to further the profession of surgery.

Evidence-Based Educational Research

EBM has not generally been applied to educational research, but the concepts utilized in EBM are directly applicable to educational research and should be familiar to

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all academicians. In fact, medical educators should teach information using methods that have been proven best based upon research. This is extremely important in medicine, with the students being held responsible for an exponentially growing knowledge base with restrictions limiting work hours and class time. Teaching that minimizes the learning curve while maximizes information retained is the key to educational success for students.

Academic surgeons, their students, and the curriculum are readily available and should be studied at all academic institutions. This does not require special laboratory equipment or assays for benchtop studies, funding for multiple expert professions outside of medicine, or recruitment of surgical patients willing to consent to participate in outcomes studies. In addition, academic surgeons involved in curriculum design based upon educational research often have the benefit of seeing the immediate application of their results to their profession. For example, if one curriculum is found to outperform another at a particular institution, the highest performing curriculum can be almost immediately adopted. For these reasons, surgical education research represents an attractive research focus for academic surgeons.

Developing a Line of Surgical Education

Research

Professional Benefits to Conducting Surgical

Education Research

Besides improving the surgical profession, academic surgeons involved in educational research can achieve career advancement, develop a national prominence and reputation, acquire funding, and significantly contribute scholarly work that makes them stand apart from those in community practice.

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Forums for Surgical Education Research

A variety of national surgical organizations have large portions of meetings and journals specifically devoted to surgical education.These groups include theAssociation for Academic Surgery (AAS), the American College of Surgeons (ACS), the Association of Program Directors in Surgery (APDS), and the Association for Surgical Education (ASE). A variety of nonsurgical medical associations also exist for the primary purpose of medical education and include the Association of American Medical Colleges (AAMC) and the International Association of Medical Science Educators (IAMSE). These groups offer forums for academicians to present their work, gain notoriety, and develop a network of contacts to further their investigations.

Conducting Surgical Education Research

All research projects require several fundamental resources for success. One of the most important of these, from an academician’s point of view, is the time required to facilitate the research project. As clinical responsibilities rise, the most efficient use of clinician time involves focusing research on activities conducted regularly, which includes teaching. Teaching should be a high priority for academic surgeons, and most find themselves in the “teaching mode” not only during lectures, but also at various points throughout the day. Teaching may take place anywhere, including a laboratory, classroom, ward, clinic, conference room, and operating room.

All human research involves participants, data collection, analysis, and dissemination of the results. A benefit of surgical education research is that the “participants” are often medical students and residents, thus affording an almost endless supply of potential participants for research studies. Data can be collected on these participants at regular intervals in the form of exam results, grades, ratings on

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standardized patient interactions, performance on simulators, and case log entries, as a few examples. These metrics aimed at measuring competence or educational achievements are routinely gathered as part of the business of surgical education. Results of surgical education research using these metrics can be provided to the participants and the faculty, and can spur immediate improvement in education.

A small amount of innovation is required to make information obtained through routine medical instruction scholarly. Research involves asking a question and obtaining an answer in a systematic and thoughtful manner. Scholarly activities involve routinely asking questions about daily activities in academic surgery and evaluating the information received. Research involves answering these questions using the information received, and scholarship relates to the dissemination of these research results. Thus, properly researching a question without the subsequent dissemination of results is, in fact, not scholarly.

One laudable goal, therefore, is to move from “just teaching” to simultaneously teaching while completing a research project that evaluates that teaching. This involves asking a novel or meaningful question about an educational issue, implementing a curriculum that will help answer the question with properly designed assessment measures, analyzing the outcomes, and disseminating the results. Clearly, the only differences between teaching and teaching with research involve: (1) developing an appropriate hypothesis – a good research question; (2) developing a research protocol, which is a document describing what curriculum, measures, analysis, and study activities will be used to answer this question; (3) obtaining human subjects approval to conduct the research study; (4) implementing the research protocol; and (5) analyzing the outcomes and disseminating the results. In benchtop and surgical outcomes research, analyzing the outcomes and disseminating the results are also done, but are directed to a different audience. The results of surgical education research are directed toward educators, faculty, medical school administrations, medical students, and residents.