Diseases of the gastrointestinal tract, including the esophagus, stomach, small and large intestine, pancreas, liver and gallbladder are common, debilitating, and incompletely understood. Excessive or dysregulated inflammation drastically alters the normal function of the gastrointestinal tract and may precipitate remote organ dysfunction, chronic inflammatory conditions or cancer. Disorders of motility, secretion and response to injury affect all regions of the gastrointestinal tract. Obesity is an established epidemic.
Many of these diseases are treated by surgery. Since the mechanisms of these diseases are poorly understood, and as surgical intervention is often required to treat these diseases, it is essential to provide the 21st century surgeon-scientist with the tools and training necessary to make important new discoveries and develop innovative therapies.
Challenges of Traditional Research Model
The traditional model of surgical research has been to train surgery residents in the laboratories of practicing surgeon-scientists, and for trainees to subsequently develop independent research programs. Although successful in the past, changing societal, governmental and individual priorities demand that this model evolve.
As noted by Dr. Francis S. Collins, Director, National Institutes of Health, in his seminal article "Reengineering Translational Science: The Time Is Right",
Despite dramatic advances in the molecular pathogenesis of disease, translation of basic biomedical research into safe and effective clinical applications remains a slow, expensive, and failure-prone endeavor. (View full PDF)
The unfortunate reality for many surgeon-scientists is that numerous factors have conspired to make it exceedingly difficult to secure extramural grant funding early in their careers:
- The combined effect of a long clinical training period, frequently 9-10 postdoctoral years
- The need to demonstrate clinical proficiency
- Increased institutional pressures to be clinically productive
- Lack of protected time
- Decreased national funding levels
The 21st Century Surgeon-Scientist
Throughout the history of medicine, surgeons have been effective problem solvers, as evidenced by each of the ten Nobel laureates who practiced surgery. From Emil Kocher (thyroid surgery) and Frederick Banting (insulin) to Alexander Fleming (penicillin) and Joseph Murray (kidney transplantation), these surgeons have combined enormous curiosity with innovative thinking to develop practical solutions to important clinical problems. This innovative training fellowship reflects an evolution in how to train the surgeon-scientist of the future. We look to move the surgeon-scientist out of the traditional basic science laboratory and into the expanding, multifaceted world of applied research and biotechnology.
With fewer than 250 NIH-funded surgeons in the United States, we are compelled to re-design our surgeon-scientist training programs in order to secure the future scientific contribution of the clinical discipline. Specifically, contemporary training programs must leverage the innate curiosity, inventiveness and clinical insights of surgeons with the research tools and skills necessary to complete and accelerate the transfer of knowledge from the bench to the operating room and the bedside.
Evolution of the Training Model
To pursue opportunities for impactful translational innovation within the field of gastrointestinal surgery, we propose an evolution in our current training program wherein surgical trainees focus on one of three tracks: preclinical, clinical or translational research. General surgery residents will train with members of a multi-disciplinary group of faculty mentors following an individually tailored program that encompasses a base curriculum plus specialized training in one of three focus areas. This approach is designed to enable trainees to mature into independent investigators who can be clinically productive while also making novel, relevant contributions to the practice and science of gastrointestinal surgery.
Specifically, the base curriculum will include didactic courses in biostatistics, scientific writing, grantsmanship, and ethical research and communication, and will be combined with specialized courses such as clinical trial design, database management and fundamentals of bio-entrepreneurship.
The training program is designed to provide rigorous training to three general surgery residents who will spend two (occasionally three) years engaged in full-time research, training that will give them with the tools required to bridge the gap between laboratory and observations on the one hand, and applied diagnostics and therapeutics on the other. These trainees will be thus empowered to become tomorrow's leaders in academic surgery devoting substantial effort to applied research focused on surgical problems involving the gastrointestinal system.
At the conclusion of the two-year fellowship, each trainee will be expected to have:
- Participated in a series of prescribed and elective didactic courses
- Made research presentations at local and national meetings
- Written at least two abstracts, two original manuscripts and a grant application based on their work
The goal of the program is for trainees to have a productive research fellowship, one that will provide them with the tools for future professional success, and enhance their value as prospective junior faculty members.
Commitment to Diversity
UCSF as an institution has a serious commitment to the active recruitment and retention of underrepresented minorities and women as students, fellows and faculty. The leadership and faculty of the training program are strongly committed to recruiting qualified underrepresented minority candidates. Importantly, the Department of Surgery similarly reflects the institution’s commitment to diversity having recruited underrepresented minorities and women at all levels. The leadership and faculty will undertake several efforts to recruit women and underrepresented minority candidates and thus celebrate and enhance our collective diversity.
New Web Portal to Evangelize Our Mission
While the obstacles to research funding have been challenging, we are nonetheless confident that the young men and women who have completed our training program possess the requisite intellectual curiosity, passion and dedication to succeed, albeit on a delayed time frame compared to their counterparts in the medical specialties.
To that end, we have created a new and vibrant web portal designed to both advertise the program to prospective trainees, and to reach out to former trainees in order to assess their challenges as academic surgeons, and determine how to best address them. The website will be a wonderful and efficient mechanism for maintaining a long-term longitudinal relationship with our trainees.
The web portal enables program participants to submit updates, news stories, and to provided anonymous or personal feedback to program leadership. in so doing, the website creates a sustainable ecosystem for its members, a growing “family tree” through which trainees and faculty can stay connected through shared activities — past, present and future.
For thirty years, nearly a third of a century, the NIH-funded T32 Research Training Grant in Gastrointestinal Surgery at UCSF has trained general surgeons to conduct cutting-edge research into diseases of the gastrointestinal tract. The new paradigm we have developed will provide general surgery residents the rigorous training that will empower them to become tomorrow's leaders in academic surgery. We hope you enjoy our new web portal and utilize its resources to advance your career.
Hobart W. Harris, M.D., M.P.H.
Professor and Chief, Division of General Surgery
Vice-Chair, Department of Surgery
J. Engelbert Dunphy Endowed Chair in Surgery
Director, Center for Hernia Repair & Abdominal Wall Reconstruction
Director, Infection, Injury & Immunity Lab
Program Director, NIH T32 Training Program in Gastrointestinal Surgery