A role for the surgeon-scientist? What does the "evidence" tell us?

“Background”: An article in this issue of the Canadian Journal of Neurological Sciences provides a platform for reviewing the role of surgeon-scientists in contemporary medical practice1. The article by Fady Girgis is entitled “Feasibility of a dual neurosurgeon-scientist career in Canada: a survey study”. The method used to obtain the data was an electronic survey distributed to staff neurosurgeons and neurosurgery residents across Canada. Questions were designed to identify qualities that exemplified ideal neurosurgical practice in relation to research. A neurosurgeon-scientist was defined as a neurosurgeon that spends at least 50% of his or her time performing research or research-related activities. In the case of residents the designation was based on intended practice, rather than current practice. In the results section the author presents the data from 54 neurosurgeons/residents that completed the survey, 32 of whom were current or intended neurosurgeon-scientists. The discussion reviews emergent themes such as: 1. Collaboration in research (85.2% of respondents felt that neurosurgeons who collaborate with basic scientists to conduct research are equally or more likely to obtain meaningful results compared to neurosurgeon-scientist conducting the same research); 2. The ‘ideal’ versus the ‘real’ neurosurgeon (83.3% of respondents did not feel that conducting research in addition to clinical duties was needed to become an ‘ideal’ neurosurgeon); 3. Research training in neurosurgery (85.2% of respondents were in favor of academic centres employing purely clinical neurosurgeons alongside neurosurgeon-scientists, rather than hiring only neurosurgeon-scientists, though 77.8% of respondents reported feeling pressure to publish journal articles). The author concludes that it is possible to do good work in both neurosurgery and neuroscience simultaneously, but in reality it is very difficult to do so. “Methods”: The author of this editorial performed a PubMed search using the term ‘surgeon-scientist’. The articles were reviewed in varying levels of depth according to the information provided in the title and/or abstract. Themes from the articles are reported and discussed using the spirit and the space limitations of an editorial. “Results”: The PubMed search revealed 163 articles containing the term ‘surgeon-scientist’ (term ‘physicianscientist’ identified 777 articles!). Survey of these 163 articles revealed: 1. Many articles that were tributes and/or obituaries to/for eminent surgeons (surgeon-scientists) including the general surgeon Beaumont2, the neurosurgeon Rasmussen3 and the plastic/transplant surgeon Murray4; 2. Many articles that were editorials/opinion pieces/published addresses, including those by Nobel laureates5-7, presidents of academic surgical societies8,9, presidents of scientific societies10-12, and editors of prominent journals13,14; 3. A smaller number of articles that did gather some data around the topic (surveys/data base extraction), especially as related to training15,16 and funding17 of the surgeonA Role for the Surgeon-Scientist? What Does the “Evidence” Tell Us?