​Research and the scientific method are integral to surgical innovation. Surgical techniques and technology has come a long way since its early days.   All driven by physicians who believe in the scientific method, labour to bring about the advances and mentor others who believe in the same.

The anomaly is that in training researchers, Surgery does worse compared to other specialties. Also, 78 per cent of surgeons stop doing research in their career.

Dr Allan Kirk, Professor of Surgery and Chair, Department of Surgery at Duke University Medical Center, then posed the question, “So are we going to be consumers, or producers?”

"Your Operating Theatre needs to be part of your laboratory.”

Dr Kirk and his colleagues from Duke University Medical Center, Dr Jeffrey Lawson, Professor of Surgery and Vice Chair of Research, and Dr Theodore Pappas, Distinguished Professor of Surgical Innovation and Vice Dean for Medical Affairs, spoke at the AM•EI Education Grand Round on 6 January at Academia.

At the event, titled “The Surgeon Scientist: Training, Research and Academia,” the panel shared with some 50 surgeons attending on the importance of the scientific ethos in the modern practice of surgery.

The current state of research in the US creates a challenge with less funding available for more investigators.   Dr Lawson emphasised, “Left to market pressures, research can diminish. This will manifest as short-term clinical efficiency but long-term loss of capacity do discover and innovate. We will keep doing the same operations and never advance.”

The problem may be that surgeons are distracted by clinical service.  Dr Kirk said, “The reward for doing research is that you get to do research. Find people who find this rewarding and we will have surgeons focused in research.”

With these challenges, Dr Lawson said that the medical institution require explicit support for the research mission and dedicated programs designed to produce surgeon-scientists. Duke has taken this to practice through their General Surgery research residency program, a two-year training dedicated to a wide range of research.   Dr Lawson shared the happy result: “It is not uncommon for our residents to produce 20-30 manuscripts at the end of the program.”

Dr Kirk advised that for success in research, surgeons has to find a niche where being a surgeon is an advantage, “your Operating Theatre needs to be part of your laboratory.”

Early in his career Dr Lawson asked, “Can we engineer blood vessels for bypass?”   This question has resulted in the world’s first tissue-engineered graft in the world for dialysis 15 years later. Sixty of such procedure have been done since.

"The mindset is ‘I will do everything possible to support those who do research'."

The development of the graft involved surgeons, engineers, people in benchmarking, policies, animal trial, pathology, clinical research and other specialists.   Dr Lawson highlighted that “Research success takes a huge team of collaborators.   They all exist in our institution, and I believe they all exist here in Singapore.”

But what makes it all work in Duke is their culture. Dr Kirk said, “Research is not seen as something different.   Everyone joins our institution knowing our mission.   When students aspire to do research, they have many mentors who can help them. 

“Research accomplishments are also the hospital’s best marketing tools. Patients go to Dr Lawson because of his stature in research – an operation can be done anywhere else.”

Dr Pappas added, “There shouldn’t be a misconception that all surgeons in Duke has a laboratory. Every surgeon there supports research in different ways. They cover for each other to ensure that there’s time for the researchers to do research.”

“The mindset is ‘I will do everything possible to support those who do research.   I want my colleague to win a Nobel prize, even if I can’t".

Prof London Ooi, Academic Chair of the SingHealth Duke-NUS Surgery ACP and SGH Division of Surgery Chairman, wrote a response to Dr Allan Kirk's presentation.