“Operating is just the tip of the iceberg - the visible face of a surgeon’s cognition”¹

Why is it important for a surgeon to be academically active? Perhaps I cannot give a precise definition, but I can share what I have learned with great masters, who in my opinion are an example of academic surgery. The first thing I realized is that knowledge of medical literature and scientific reasoning are fundamental pillars of our clinical practice. I understood that evidence is much worthier than opinion and that good decisions can hardly be made without knowing the mistakes of the past. I remember countless discussions in my two mentors’ offices that always ended the same way: with a scientific paper in my hands and the arguments and answers I needed. Complemented, of course, by the invaluable clinical experience they passed on.

To be academically active is to constantly ask ourselves if we are doing what is right or if there is a way to improve our results. To a certain extent, this is a way of putting the current recommendations periodically in check. No one better than an active and experienced surgeon to ask a question that may trigger an investigation. Research allows us to produce scientifically based evidence from our own experience and then compare it with that of others. Undoubtedly, academic activity removes borders and allows interaction with the international surgical community. An article can be read and analyzed by surgeons in a remote part of the world, and vice versa.

Academic activity is more than just presenting a paper at a conference or publishing a scientific article; it means identifying a learning opportunity in each patient we treat and achieving an objective evaluation of former patients to obtain better results with future patients.

Being an academic is also being innovative. The search for new surgical techniques and the development of new therapeutic approaches is undoubtedly an important task. Today, more than ever, we need a solid knowledge basis and critical judgment to adopt or reject the constant new products developed by the industry. Being an academic clearly implies an extra effort, since research (reading, analysis, writing, etc.) usually takes place during non-working hours or days. What I really learned from my mentors is that research involves sacrifice. However, this sacrifice is almost always accompanied by great satisfaction and reward².

Why is it difficult to publish in Argentina? In my opinion, several elements of our system of surgical education, training and practice hinder research in our country.

▪ Lack of resources for research: the major academic surgical centers worldwide count with funds from the Department of Surgery allocated to research. When I speak of research, I am not necessarily referring to experimental research laboratories with enormous resources (which many of them also have), but to those assigned to clinical research (research fellows assigned to investigation, personnel dedicated to data collection, epidemiologists, biostatisticians for data analysis, etc.). In turn, staff surgeons usually have protected research time, which is paid or considered as part of their monthly workload. In the current context of the country, demanding large economic resources for research would be Utopian. However, it is possible to start ensuring blocks of time (a very valuable resource) for academic activity for residents and staff physicians.

▪ Lack of knowledge of the scientific method: the analysis and interpretation of information requires knowledge and training in the scientific method. Unfortunately, few residency programs in surgery include such learning in the curricula. Statistical analysis constitutes a barrier for most surgeons. For this reason, basic teaching of statistical analysis should be formally promoted by the different training programs.

▪ Inadequate collection of patient data: scientific work is impossible without a complete and detailed database. While time constraints and physicians’ exhaustion make this process difficult, patients’ data from electronic records should be collected. Many developed countries have national databases (public, private, developed by surgical societies, etc.) that serve as a platform for research articles.

▪ Lack of mentors: although there are great surgeons with vast experience, the mentor-mentee dynamic is unusual in our country. It is important for the resident to have someone to turn to periodically to develop his/her academic activity. The mentor may be part of another institution, something nowadays made easier by the development of virtual communications.

In conclusion, I believe that academic activity should be a fundamental pillar not only during surgical training, but also, if possible, throughout the entire surgical practice. The current challenges that hinder research in surgery must be made visible and periodically evaluated to increase surgical academic activity in Argentina.