DISCUSSION

Research has an important role in the academic growth of residents and scholarly requirements are now a firm component of accredited residency programs. The ACGME stated that residents should provide a manuscript for publication in a peer-reviewed journal by the end of their training. Research productivity has shown a positive association with clinical performance and rate of employment, particularly in terms of fellowship and academic positions (Haas et al., 2023). As is noted across the United States, residency is a highly demanding training stage, and trainees may encounter various obstacles as they attempt to initiate and evolve a research project. Thus, identifying the barriers residents face has become critical.

While evaluating the current otolaryngology resident team, a significant association between DRE prior to residency and research productivity during residency was established. This was indirectly supported by the positive correlation between the alumni’s pre-residency publication count and productivity throughout residency. Also, h-index score and first authorship were significantly higher in trainees with prior DRE, both of which are highly valued in the academic setting (Ashfaq et al., 2018). In the literature, similar results were presented for the ophthalmology field by Pur et al., (2024) as they found greater research productivity during residency among those who had at least one publication pre-residency. Furthermore, they were able to establish an association between pre-residency research productivity and immersion in fellowship training and academic careers (Pur et al., 2024). These findings highlight the importance of identifying which trainees require additional support and mentorship, providing them with valuable assets necessary for an academic path. 

Overall research productivity was greater in two scenarios: fellowship trained physicians and academic-bounded practitioners. Alumni who pursued a fellowship after residency evidenced a higher publication count and h-index score. In addition, when evaluating research productivity among fellowship types, a significant difference was established across total publication count. This difference was primarily influenced by the incredible publication output of pediatric otolaryngologists. Interestingly, this correlates with findings by Kirubalingam et al., who demonstrated a significant increase in the number of articles published in pediatric otolaryngology from 2013 to 2021 (Kirubalingam et al., 2023). As previously mentioned, practice also influenced total publication count, and this is explained by the increased funding and infrastructure academic otolaryngologists have access to. 

This study revealed that both time and infrastructure support are seen as the main elements affecting research productivity. Residents expressed favoring a balance between clinical work and personal life, which aligns with findings in the published literature (Merino et al., 2023). Methodological support is also a relevant barrier, primarily among residents who have had less experience with research. Furthermore, faculty members pointed out that a lack of focused interest also curtailed the research process, emphasizing the need for direct mentorship and guidance starting from early stages of training. Ahn et al. studied the interest in research among orthopedic surgery residents and found an inclination towards clinical investigation given its direct relevance to their practice (2010). In addition, they found interest was positively correlated with previous research experience, first authorship, and age (Ahn et al., 2010).

Time as a Barrier

During surgical residency, time is constrained by work-hour restrictions, surgical caseload, clinical responsibilities, educational requirements, and social needs (Merino et al., 2023). The perception of time as the primary barrier for research is a consistent finding across other medical specialties, including ophthalmology and plastic surgery (Al-Taha et al., 2017; Pur et al., 2024).  As shared by the group of residents included in this study’s survey, although there is a genuine motivation for conducting research, surgical and clinical evolution is prioritized, and their limited time off duty favors quality time with family and friends. Allocating a specific time frame for research is commonly proposed by residency programs, however there is no consensus on how long this protected time should be and how it should be distributed. Programs may advocate for month-long dedicated time, while some others have implemented weekly dedicated time (Clark et al., 2021). Moreover, to encourage a career path leading to academic positions and the development of clinician-scientists, certain programs have chosen to add an entire year dedicated to research (Stevenson et al., 2017). This year can be structured as a standalone program or aimed at completing a master’s or PhD degree (Zuo et al., 2020). In general, published studies agree strictly established protected research slots embedded in the residency educational curriculum should be implemented to help trainees integrate research into their practice (Al Absi et al., 2024; Al-Taha et al., 2017).

Infrastructure as a Barrier

Residents oftentimes find themselves facing restrictions related to study logistics. For example, statistical analysis may require personal skills or a specialized statistician. Either of these are provided by a robust research infrastructure. Moreover, equipment, facilities, and services required for the continuation of projects should be readily available during protected research rotations given the limited time trainees have away from clinical work. Teamwork among residents is also an important component of the research infrastructure. Cultivating a culture of research within the department is particularly important when encouraging faculty and residents to engage in mutual scholarly activities (Nocera et al., 2016). This means equipping them with the necessary tools to facilitate research workflow. Studies have shown a benefit in research productivity with infrastructure improvement strategies such as including dedicated research staff in the department, providing access to experienced statisticians, and creating multidisciplinary research teams (Seehusen et al., 2023).

Mentorship as a Barrier

Creating a mentor-mentee relationship can have a positive impact in both clinical and scholar growth, and its success relies on mutual interests and compatible working style (van Schalkwyk et al., 2017). In addition, each mentee might have different needs given their academic background, and these should be acknowledged by those providing guidance. Aside from nurturing a resident’s curiosity, mentors may also serve as point of contact for other specialists that can further collaborate with their expertise. Mentorship should be established as early as possible, meaning intern year or second year of residency, to take advantage of such guidance in the process of developing a research question. From there on, a sense of commitment is developed, and the execution of the project can be supervised along the way. Furthermore, peer-to-peer mentorship should also be considered as senior residents themselves can serve as mentors and collaborate in projects with interns and junior residents (Chiu et al., 2019). Of note, the results revealed a nearly significant direct trend in the correlation between residency training stage and the cumulative publication count during residency, emphasizing on the experience that can be passed on from senior residents to juniors and interns.

Interest as a Barrier

For residents, having a clear interest can help develop a research question that fulfills their intellectual curiosity. Typically, those interested in pursuing an academic path have greater motivation. As was noted in this study’s results, residents in the first years of residency have not yet decided which career path matches their expectations. Mentorship may be the most straightforward strategy to increase interest as mentors contribute with a broader and more indepth perspective of a particular field. 

Although the majority of residents in this study value research as an important aspect for their training, a lack of interest evolves secondary to time and infrastructure limitations. Incentives such as financial support and awards have both been proposed as means to increase interest in research work. Haas et al. mentioned awards were associated with higher rate of project publication (2023).   

Funding as a Barrier

Funding resident research is paramount for the execution of projects and participation in scientific meetings. The lack of financial support can work as a disincentive for research and should be adequately addressed. Funding research represents a significant expense, especially for those who are not supported by external entities such as the National Institutes of Health (NIH). Skube et al. proposed a strategy in which residents receive partial support through partnership with the local industry (Skube et al., 2018). They were successful in this approach by facilitating a paid immersion course in which the industry could have a first-hand experience in the operating room and clinical environment completely guided by residents. Finally, competing for grant funding can be challenging and requires a significant effort. Seehusen et al. showed making grant writing expertise available to trainees and faculty members increased the level of research capacity in up to 75% of the assessed family medicine departments (2023). For this study, research capacity was evaluated based on the number of peer-reviewed publications, research grants, percentage of departmental funding allocated to research, among other variables (Seehusen et al., 2023).

Limitations

This study primarily represents a self-assessment of a single institution’s otolaryngology residency program. Although valuable insights can be extracted from the analysis, further investigation is needed on a larger sample, considering each program is diverse in their approach to research requirements. The same methodology could be applied to programs with a research track, establishing how longer dedicated research periods influence productivity and career evolution.

CONCLUSION

Research productivity during residency can be challenging, essentially as a result of time and infrastructure limitations. Additionally, it is important to consider that each trainee comes from a different research experience, and this can influence their interest and publication output during residency.

ACKNOWLEDGMENTS

The authors received no grant support for this work and declare they have no conflicts of interest in regard to this work.