Medical school and residency influence on choice of an academic career and academic productivity among neurosurgery faculty in the United States

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Object

Factors determining choice of an academic career in neurological surgery are unclear. This study seeks to evaluate the graduates of medical schools and US residency programs to determine those programs that produce a high number of graduates remaining within academic programs and the contribution of these graduates to academic neurosurgery as determined by h-index valuation.

Methods

Biographical information from current faculty members of all accredited neurosurgery training programs in the US with departmental websites was obtained. Any individual who did not have an American Board of Neurological Surgery certificate (or was not board eligible) was excluded. The variables collected included medical school attended, residency program completed, and current academic rank. For each faculty member, Web of Science and Scopus h-indices were also collected.

Results

Ninety-seven academic neurosurgery departments with 986 faculty members were analyzed. All data regarding training program and medical school education were compiled and analyzed by center from which each faculty member graduated. The 20 medical schools and neurosurgical residency training programs producing the greatest number of graduates remaining in academic practice, and the respective individuals' h-indices, are reported. Medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academics the most frequently. The neurosurgery training program at the University of Pittsburgh produced the highest number of academic neurosurgeons in this sample.

Conclusions

The use of quantitative measures to evaluate the academic productivity of medical school and residency graduates may provide objective measurements by which the subjective influence of training experiences on choice of an academic career may be inferred. The top 3 residency training programs were responsible for 10% of all academic neurosurgeons. The influence of medical school and residency experiences on choice of an academic career may be significant.

Abbreviations used in this paper: ACGME = Accreditation Council on Graduate Medical Education; WOS = Web of Science.

Abstract

Object

Factors determining choice of an academic career in neurological surgery are unclear. This study seeks to evaluate the graduates of medical schools and US residency programs to determine those programs that produce a high number of graduates remaining within academic programs and the contribution of these graduates to academic neurosurgery as determined by h-index valuation.

Methods

Biographical information from current faculty members of all accredited neurosurgery training programs in the US with departmental websites was obtained. Any individual who did not have an American Board of Neurological Surgery certificate (or was not board eligible) was excluded. The variables collected included medical school attended, residency program completed, and current academic rank. For each faculty member, Web of Science and Scopus h-indices were also collected.

Results

Ninety-seven academic neurosurgery departments with 986 faculty members were analyzed. All data regarding training program and medical school education were compiled and analyzed by center from which each faculty member graduated. The 20 medical schools and neurosurgical residency training programs producing the greatest number of graduates remaining in academic practice, and the respective individuals' h-indices, are reported. Medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academics the most frequently. The neurosurgery training program at the University of Pittsburgh produced the highest number of academic neurosurgeons in this sample.

Conclusions

The use of quantitative measures to evaluate the academic productivity of medical school and residency graduates may provide objective measurements by which the subjective influence of training experiences on choice of an academic career may be inferred. The top 3 residency training programs were responsible for 10% of all academic neurosurgeons. The influence of medical school and residency experiences on choice of an academic career may be significant.

Academic neurosurgery is not only the training ground for future generations of neurosurgeons, but also often the source for clinical innovations and scientific advancement.4 For institutions, departments, physicians, and the prospective students of academic neurosurgery, the benefits of academic productivity are clear.

The multiple influences that drive an individual to seek an academic career are unclear. Encouraging pursuit of academics is a primary goal of neurosurgery training programs; a core tenet of the academic mission of organized neurosurgery is “to promote and encourage scientific research, elevate and sustain the education of physicians in formal institutions of learning.”7

In academic medicine, productivity is difficult to measure. To economists, the term productivity refers to the ratio of output to input, which is most often measured as capital.18 Accordingly, an established measure of academic success has often been the amount of National Institutes of Health funding obtained by a department.13 Other metrics historically examined include the number of peer-reviewed scholarly articles published, clinical productivity, number of faculty, and the academic degrees held by the faculty.12,19

A recently proposed measure, the h-index, is based on an author's most cited articles and the number of citations each of these articles receives.11 This measurement evaluates the combination of quantity as well as the quality of papers produced, based on peers' citations. The above measures are often compared in aggregate to assess the contribution of each center to the current academic milieu. Little attention has been directed toward the ability of centers to inspire graduates to enter academic medicine and to enrich other academic institutions with human capital.

While academic training programs ostensibly seek trainees with the greatest potential for academic contribution, factors influencing the choice of an academic career are not fully understood. The influence of training on choice of an academic field is assumed, but not fully explicated.5

This study is the first in a series to explore factors influencing choice of an academic career in neurological surgery and other medical subspecialties. This investigation centers on the assessment of the impact of medical school and residency experiences on the decision to pursue a career in academic neurosurgery. This analysis also provides an estimation of the most productive medical schools and residency programs based on the academic productivity of their graduates. Using this indirect means of comparison, a first step is taken in understanding the factors contributing to choice of an academic neurosurgery career.

Because there is no single universally accepted measure of academic productivity, this study benchmarks relative rankings across training centers in the US based on respective centers' graduates. In addition to the respective endowment of human capital generated, h-index-based metrics are considered to provide an appraisal of all medical schools' and US training programs' contribution to academic neurosurgery.

Methods

Selection of Programs and Neurosurgeons

A list of 99 neurosurgery programs in the US and Puerto Rico accredited by the ACGME was obtained from the FREIDA website (http://www.ama-assn.org/go/freida). All biographical information about individual faculty members was identified from every program via an internet-based search that was conducted during December 2009. Faculty members were included only if they were involved in resident education through being members of ACGME-accredited residency training programs. Faculty lists were obtained from institutional websites. The highest academic degree(s) was cataloged. Academic rank was recorded as instructor, assistant professor, associate professor, professor, and/or chairman (department or division director). Any nonneurosurgeon, researcher, or professor emeritus listed as faculty was excluded from our analysis. All individuals who did not possess an American Board of Neurological Surgery certificate (or were not board eligible) were also excluded. Residents and fellows were not included in this analysis. Departments with limited disclosure of staff physicians on their website (2 programs) were excluded from analysis. The institutions where faculty members completed medical school and residency training were also recorded. In the vast majority of cases, this was available from the departmental website; however, if the information was missing, a second search was performed at www.drscore.com. The associated medical school was unavailable in 32 individuals and data regarding residency completion was missing for 17.

Calculation of the h-Index Using Scopus

For each faculty member, a custom search was performed using Scopus (www.scopus.com), which offers full citation coverage from 1996 onward.2 The first and last names were entered into the author search function to create a search string. If necessary, the Scopus results were then used to refine each faculty member's full name, including middle initial and preferred variations of the author's name used in published articles. The title of the most recent published paper of inexact matches was viewed to determine whether the approximate match should be appended to the author's publications, regardless of the publication's institutional affiliation. The Citation Tracker function was then used to generate the associated h-index for each individual. Searches were conducted randomly by program in a single week of May 2010 by a single data collector in an attempt to minimize any temporal bias.

Calculation of the h-Index Using WOS

Another engine used to gather h-index values was Thomson's Institute for Scientific Information Web of Science database (http://isiknowledge.com), which contains citation data from 1900 to the present.1 Using WOS, a search was performed using surname and the author's preferred initials as reported in peer-reviewed literature (typically first and middle initial) to obtain a citation record. Institutional association was not used as a search limitation. Citation results for this engine were not further refined. The citation report provided a summary of the standard bibliometrics including the h-index. Searches were conducted randomly by program in a single week of May 2010 by a single data collector in an attempt to minimize any temporal bias.

Statistical Analysis

Analysis of variance was performed using the Tukey range test to detect if h-indices were associated with academic rank. All statistical analyses were performed using the SAS-based statistical software package JMP (SAS Institute, Inc.). Significance was defined as p < 0.05.

Results

Based on departmental websites, 97 (98%) of 99 programs provided information on 986 currently practicing academic neurosurgeons (Table 1). The institution where the neurosurgeon in question completed medical school and residency was identified with 96.8% and 98.3% effectiveness, respectively. Faculty rank was available for 86.2% of the sample. Among these, 11 (1.3%) were instructors, 334 (39.3%) were assistant professors, 211 (24.8%) were associate professors, and 294 (34.6%) were full professors.

TABLE 1:

Results available after internet-based analysis of 97 neurosurgery programs

VariableValue% Capture
Total AvailableTotal Collected
no. of programs999798.0
no. of faculty986
 faculty rank/position known98685086.2
 medical school known98695496.8
 residency program known98696998.3

All data regarding training program and medical school education were compiled and analyzed by center from which the faculty member graduated. All medical schools (including foreign institutions) and ACGME-accredited residency programs were tabulated. These data were investigated to determine the most productive medical schools and residency programs as a function of their tendency to produce academic neurosurgeons. Residency training programs produced a range from 1 to 37 academic neurosurgeons with a median of 5. In the interest of brevity, only the top 20 medical schools and residency programs will be fully outlined in this report (Tables 2 and 3). The 3 most effective medical schools at producing academic neurosurgeons practicing in the US were Columbia University College of Physicians and Surgeons, Johns Hopkins University School of Medicine, and Harvard Medical School. By training program, the University of Pittsburgh Medical Center; University of California, San Francisco; and New York Presbyterian Hospital (Columbia) produced the greatest number of graduates remaining in academics.

TABLE 2:

The 20 most productive residency programs by graduates remaining in academic neurosurgery and mean Scopus and WOS h-index scores of graduates

RankProgramNo. of Graduates in Academic NeurosurgeryWOS Mean h-IndexScopus Mean h-Index
1University of Pittsburgh3715.9210.59
2University of California, San Francisco3624.8614.94
3Columbia University3119.7113.81
4Massachusetts General Hospital2922.9015.21
5University of Washington2821.512.64
6University of Virginia2621.5813.69
6New York University2613.158.88
8Johns Hopkins University2219.4113.86
9University of Pennsylvania2024.4513.65
9Northwestern University2019.206.55
9University of Minnesota2015.006.35
12Case/University Hospitals1927.2111.53
12Barrow Neurological Institute1925.6311.32
12University of Southern California1923.3211.58
15Washington University1817.3911.11
15Duke University1816.5012.17
17University of California, Los Angeles1722.2915.12
18University of Michigan1627.1313.00
19Vanderbilt University1521.736.73
19Albert Einstein1520.337.13
TABLE 3:

The 20 most productive medical schools by graduates remaining in academic neurosurgery and mean Scopus and WOS h-index of graduates

RankProgramNo. of Graduates in Academic NeurosurgeryWOS Mean h-IndexScopus Mean h-Index
1Columbia University4017.2812.53
2Johns Hopkins University3322.9113.88
3Harvard Medical School3223.5915.69
4Weill Cornell Medical College2315.0010.48
5Case/University Hospitals2023.4512.75
6Northwestern University1820.1112.22
7University of Pennsylvania1720.2912.06
7University of Michigan1718.3511.88
7University of Illinois1716.948.76
10Yale University1628.5611.75
10University of Virginia1618.2513.50
12Stanford University1428.0715.79
12Indiana University1419.0011.50
12New York University1416.368.21
12University of Cincinnati1412.438.07
16University of California, Los Angeles1322.316.85
16University of Chicago1320.009.31
16Albany Medical College1314.549.31
16Duke University1314.3810.85
16Georgetown University1311.386.31

The top 3 training programs, with regard to trainees being faculty members at time of this assessment, were responsible for 104 academic neurosurgeons (10.5% of the entire population of academic neurosurgeons assessed). Similarly, the top 3 medical schools accounted for 10.5% of all academic neurosurgeons. The top 20 programs produced a total of 451 academic neurosurgeons, accounting for 45.7% of the population.

In an attempt to evaluate the scholarly activity of a center's graduates, WOS and Scopus h-indices were collected and summated to provide the mean of all individual faculty h-indices. Mean h-indices for the top 20 centers have been reported (Tables 2 and 3). Among the medical schools, the WOS h-index designated those from Yale University, Stanford University, and Harvard University to have the highest academic output, while Scopus assessment found more productive faculty members were graduated from Stanford University, Harvard University, and Johns Hopkins University. Within neurosurgical training centers, mean WOS values determined graduates of Case Western Reserve University; University of Michigan; and Barrow Neurological Institute to be most prolific, while Scopus reported those graduate of Massachusetts General Hospital; University of California, Los Angeles; and University of California, San Francisco training programs to be the most academically active.

Mean h-indices were also evaluated to determine a correlation with academic rank (Fig. 1). The mean WOS h-indices were 12.6 for assistant professors, 15.9 associate professors, and 26.3 for professors. The mean Scopus hindices were 5.6 for assistant professors, 9.7 for associate professors, and 16.0 for professors. Evaluating both the WoS and Scopus values by using the Tukey range test demonstrated that a rank of professor was associated with significantly higher h-index than nonprofessor. However, only the Scopus h-index results were significantly different between the ranks of associate and assistant professor.

Fig. 1.
Fig. 1.

Bar graph demonstrating the mean WOS- and Scopus-derived h-index of academic neurosurgeons in comparison with rank.

Discussion

Determining what attracts applicants to an academic career, and which factors may predict eventual success in academics, would be beneficial in applicant counseling and in mentoring of medical students and residents. Appreciation of the influence of medical school and residency experiences may be inferred from studying the contribution of said programs to the field, as measured through output of academicians and through the productivity of academicians trained at a given facility. It is likely that medical school and residency experiences are important factors in the choice of an academic career in neurological surgery.

The assessment of an academic physician's scientific contribution often plays a significant role in the process of academic promotion, tenure determination, grant funding, and department reputation.20 In academic physics, the h-index was proposed to estimate both the quantitative output as well as the broader impact of a scientist's cumulative research contributions.11 While this metric has been used extensively in the natural sciences, the use of the h-index has only recently been reported in medical subspecialties, including neurosurgery, radiation oncology, radiology, urology, and otolaryngology.3,6,15,17,20 Within neurosurgery, several studies have attempted to provide a benchmark by which the h-index of individual academic neurosurgeons can be standardized for comparison.17,21

Medical School and Residency Impact

Most academic neurosurgeons are able to offer an approximate description of strengths and weaknesses of specific departments. Academic reputations are often summed up, with programs characterized as research powerhouses or strongly clinical programs. Some programs are construed as less robust in their research and clinical productivity.9 US News & World Report annually provides its rankings of combined neurology and neurosurgery centers using a variety of institution, patient outcome, reputation, and other metrics; these results have not correlated with more specific measures of academic achievement.19 Evaluation of individual departmental characteristics has historically been nebulous; critical assessment of program productivity has only recently begun to be investigated.

In evaluating the scholarly contribution of an overall center, outcome measures such as total number of publications, number of citations, grant award rates and amounts, professional society leadership posts, and editorial board membership have typically been used.22 Recently, citation analysis and the h-index have been adopted to serve as comparative measures of both qualitative and quantitative research activity on an interdepartmental basis.9,19

In the current study, individually collected h-indices were captured at a specific time point in an attempt to profile productivity based on the mean scholastic output of the graduates of medical schools and ACGME-certified neurosurgery residency training programs. Rather than using these metrics to compare departmental output as has been done previously, this report utilizes similar methods to compare the total gross academic output of the graduates of these medical schools and training programs, regardless of their current institutional affiliation.

Any objective analysis of the academic impact of medical schools and their affiliated clinical institutions should assess not only the overall scholarly output but also the sum of their graduates who select careers in academic medicine. Economists describe the latter as human capital, that is, the product of professional training which is afterward owned by the trained professional and may be used in the production of professional services, at the owner's discretion.10

The influence of medical school and training program on a trainee's decision to enter into a career in academic medicine (thereby endowing the entire field with continued knowledge, skill, and creativity) is poorly understood despite a wealth of studies.5 We are unaware of any previous study that has attempted to systematically evaluate the retention of graduates across an academic subspecialty. The current report seeks to use the production of academic physicians as an important metric in evaluation of medical schools and neurosurgery training programs.

Results of This Study

Many factors contribute to an individual's decision to pursue an academic career. Choice of medical school and residency may impact future choice of an academic path; experiences in medical school and residency may influence future career decision making. Assessment of the impact of medical and residency training on choice of academic pathway in neurosurgery has not been reported in the literature.

Overall, neurosurgery residencies have a median of 5 graduates in academic practice per program, with a range of 1–37 (25% quartile 1, 75% quartile 11). Several centers have produced more than 30 academicians active at the time of our assessment. The distribution of academicians in neurological surgery and the distribution of medical school and residency training programs seem to show that there may be a significant contribution of medical school and residency program experiences to career choice, with some programs showing particular productivity.

While many factors likely contribute to an individual's choice of an academic career in neurological surgery, it is possible that the influence of medical school and residency program experiences is significant. The productivity of the top programs in our assessment may indicate a specific facility of these programs in producing academicians.

H-Index Scoring

Until 2004, WOS was effectively the only engine available to obtain citation data.2 Prior to this date, nearly all citation analysis of the medical literature was performed by examining this database.16 Since this time, 2 alternatives to WOS have become available for bibliometric analysis: Scopus and Google Scholar. World of Science contains citation data from 1900 to the present, Scopus from 1996, and Google Scholar does not disclose its time coverage.1 Bar-Ilan et al.2 compared the h-indices of the publications of several highly cited Israeli researchers. They compared the citation counts reported by WOS, Scopus, and Google Scholar and found a high similarity between Scopus and WOS results and fewer similarities between these engines and Google Scholar.

While Google Scholar has been complimented for its ability to retrieve even the most obscure citations, it has been criticized for being unreliable, antiquated, containing grossly inflated citation counts, and reporting phantom authors and citations.8,14 However, among neurosurgery faculty, Lee et al. reported a high level of correlation between h-indices collected by Scopus and Google Scholar.17 In our assessment, we found better predictive value using Scopus to discriminate between assistant, associate, and full professors (Fig. 1).

Sources of Bias

This report is the first attempt to classify academic productivity as it relates to medical schools and training programs of neurosurgical faculty. This study has several limitations. All faculty members were identified by a search of the publicly available departmental websites, which may not have been up-to-date. Given the weight placed on graduates entering academic medicine, this analysis likely disproportionately favors large institutions. The top 20 residency programs found in our assessment all are approved to accept at least 2 students through the annual matching process. Hence, the increased productivity of these programs may be partially explained by the increased number of residents completing training. The study defines an academic neurosurgeon as one remaining active in resident education, and therefore only reviews ACGME-accredited training programs. Academic neurosurgeons not directly involved in resident education will be omitted from this assessment.

The h-index is a lagging indicator, with more senior faculty members generally having higher h-indices, likely due to their academic contributions being available for citation for a longer period of time. Our primary outcome measure, production of academic neurosurgeons, is also a lagging indicator, reflecting the experiences of neurosurgical faculty today when they were residents and medical students, perhaps many years prior. This may not reflect present experiences of trainees and medical students. Our snapshot of neurosurgical training programs will not reflect transition of faculty between programs. This assessment also may not represent the present status of a given training program, as each measure applied is a lagging indicator and only will report historical data.

Centers producing the highest numbers of graduates with the highest bibliometric indicators were ranked prominently; however, neither of these metrics assesses clinical volume, which many would agree is an important component of a training program. At present, we are unaware of any consistently collected, nonproprietary estimates of case volume that would allow for an interdepartmental comparison. The current report does not examine graduates' effectiveness in patient care, teaching ability, or involvement in organized neurosurgery.

A direct measure of factors leading to choice of an academic career and producing success within an academic career is impossible. Only through assessment of population metrics and through measurement of individual productivity can we estimate institutional impact. It is highly unlikely that there is a causal relationship between choice of a given training program and success in an academic career. However, there appears to be some tendency for specific neurosurgery training programs to generate academic neurosurgeons.

Conclusions

This report seeks to evaluate the academic productivity of medical schools and neurosurgery residency programs based on the number of their graduates remaining active as faculty members in residency training programs and the productivity of each of these graduates as measured by the h-index. The top 3 neurosurgery residency training programs were responsible for 10% of all academic neurosurgeons at the time of assessment. While past performance is not necessarily indicative of future results, this study provides an objective measurement of the current contribution of medical schools and neurosurgical training programs to academic neurosurgery. The impact of experiences in medical school and residency training may be one factor influencing choice of an academic career in neurosurgery.

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author contributions to the study and manuscript preparation include the following. Conception and design: Ratliff, A Moshfeghi, Leng, D Moshfeghi. Acquisition of data: Ratliff, Campbell, Awe, Maltenfort, Leng, A Moshfeghi. Analysis and interpretation of data: all authors. Drafting the article: Ratliff, Campbell, Awe, Maltenfort. Critically revising the article: Ratliff, Campbell, Maltenfort, D Moshfeghi. Approved the final version of the paper on behalf of all authors: Ratliff. Statistical analysis: Maltenfort. Administrative/technical/material support: Ratliff, Maltenfort, D Moshfeghi. Study supervision: Ratliff, D Moshfeghi.

Acknowledgment

The authors would like to thank Thomson Reuters for providing temporary complimentary access to the Web of Science search engine.

References

Article Information

Address correspondence to: John K. Ratliff, M.D., Department of Neurosurgery, 909 Walnut Street, 2nd Floor, Philadelphia, Pennsylvania 19107. email: john.ratliff@jefferson.edu.

Please include this information when citing this paper: published online April 15, 2011; DOI: 10.3171/2011.3.JNS101176.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph demonstrating the mean WOS- and Scopus-derived h-index of academic neurosurgeons in comparison with rank.

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