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Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.JournalofSurgicalResearch.com

Real world versus ivory tower: the challenge for academic surgery Lillian S. Kao, MD, MS, FACS* Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas

article info

abstract

Article history:

Academic surgeons increasingly must balance scientific pursuits with the demands of

Received 11 February 2014

maintaining a clinical practice. This article describes the core values of the Association for

Received in revised form

Academic Surgery and how these values can guide the survival of the society and of aca-

11 February 2014

demic surgery given the changing healthcare landscape. These values include: promotion,

Accepted 25 February 2014

diversity and inclusivity, scientific excellence, innovation, collaboration, and mentorship.

Available online xxx

By redefining academic surgery, enabling the collective mind, and harnessing technology, the society and academic surgery can be resilient in the face of current and future

Keywords:

adversity.

Academic surgery

ª 2014 Elsevier Inc. All rights reserved.

Mentoring Collaboration Research

1. Defining the challenge: real world versus ivory tower? Until 10 y ago, Fermat last theorem was considered one of unsolvable mathematical puzzles. Unlike the Pythagorean equation, a2 þ b2 ¼ c2, for which there are infinite combinations of integer solutions, Fermat last theorem states that an þ bn ¼ cn cannot be solved for any three integers a, b, and c for any integer n > 2. Fermat is said to have announced that he had proven this theorem in the margins of a book in which he claimed that there was not enough space to write it all down. He died before he could reveal his proof. Multiple attempts to solve the theorem failed, and although several integer combinations came close to disproving this

theorem, they were narrowly off at the ninth and 10th decimal places. In 1994, Andrew Wiles solved Fermat last theorem. He is reported to have aspired to solve the proof ever since he was a child. After receiving a degree in mathematics, he decided to revisit the proof and devoted himself for 7 y to find the solution. Despite this tremendous accomplishment, there were those that had difficulty in understanding this perceived ivory tower pursuit. In an interview for Nova, he was asked: “But finding a proof has no applications in the real world; it is purely an abstract question. So why have people put so much effort into finding a proof?” [1] His reply emphasized the importance of picking a problem about which one truly cares out and the need to try to solve it no matter how impossible

This article was presented at the Academic Surgical Congress, San Diego, California, February 4e6, 2014. Thank you for the privilege of serving as your Association for Academic Surgery (AAS) president this year. The passion, the energy, and the momentum of the AAS have served as an inspiration to me as an academic surgeon and as a person. In the hopes of inspiring you today, I read past presidents’ speeches, watched inspiring TED talks, and bounced ideas off of my friends and mentors whom I will thank at the end of this talk. * Corresponding author. LBJ General Hospital, 5656 Kelley Street, Suite 30S 62008, Houston, TX 77026. Tel.: þ1 (713) 566 5096; fax: þ1 (713) 566 4583. E-mail address: [email protected]. 0022-4804/$ e see front matter ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.02.052

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the problem is perceived to be. He stated that “I know it’s a rare privilege, but if one can really tackle something in adult life that means that much to you, then it’s more rewarding than anything I can imagine.” [1] Everyone here today shares a similar passion for academic surgery or we would not be here today, but can we afford to pursue academia in today’s changing environment? Can the ivory tower survive the real world? The term ivory tower is said to have originated in the Song of Solomon in the King James Version of the Bible. The Virgin Mary’s neck was compared with a tower of ivory and was regarded as a symbol of noble purity. Today, the ivory tower has become synonymous with academia or a place of learning such as the university. However, the term has come to have a negative connotation in that the inhabitants of the ivory tower are often considered to be intellectuals who are divorced from or out of touch with the real world. Nonetheless, the politics and economics of the “real world” have encroached on the ivory tower. Many past presidents have described these forces and have prognosticated on the future of surgery [2e4]. Realities include decreasing federal funding for surgeonsescientists, increasing emphasis on generation of clinical revenues, increasing need for supervision of trainees and decreasing resident autonomy, changing work-life expectations of trainees, and an evolving health care landscape in terms of tracking of outcomes, individual and hospital accountability, and pay for performance. As a result, challenges for academic surgery include: attracting and educating future academic surgeons, maintaining the ability to pursue science for science’s sake, and advancing the discipline through discovery and innovation.

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Choosing to succeed as a society

Society often looks to the lessons of the past to inform the future. As Winston Churchill said, “The farther backward you can look, the farther forward you are likely to see.” Although the Association for Academic Surgery (AAS) is a society based on a common mission rather than on geography, lessons learned from societies that have succeeded and those that have failed may be valuable. In his book Collapse: How Societies Choose to Fail or Succeed, Jared Diamond describes the fall of Easter Islanddthe most remote habitable place in the world [5]. Settled before 900 AD, Easter Island is renowned for its 887 gigantic statues with the largest ones reaching 70 feet high and weighing up to 270 tons. Erecting these statues was the work of the 12 clans that occupied the island; this required not only immense natural resources but also significant manpower, cooperation, and patience. However, despite effective collaboration within clans, different clans competed with each other to build taller and more elaborate statues. Jared Diamond and others have thus speculated that Easter Island collapsed because of two main factors: depletion of their resources (deforestation) and overfocus on statue construction. Easter Island bears similarities to the ivory tower. Like the clans of Easter Island, research laboratories compete for limited resources (i.e., National Institutes of Health funding) and require the efforts of teams of scientists. Significant

manpower, cooperation, and patience are expended to move their research forward. Is academic medicine and surgery doomed to a similar fate as Easter Island? Or are there rays of sunshine peeking through the clouds suggesting hope? What choices characterize societies that have succeeded versus failed? According to Jared Diamond, “Two types of choices seem to me to have been crucial in tipping their outcomes towards success or failure: long-term planning, and willingness to reconsider core values. On reflection, we can also recognize the crucial role of these same two choices for the outcomes of our individual lives.” [5] We can also recognize the crucial role of these two choices for our academic societies. In comparing Easter Island with the ivory tower, however, there is one key difference. Unlike the statues of Easter Island, the research being done in academic surgery is significant and relevant to the real world; surgical research directly applies to patient care and is being conducted all along the T1-T3 continuum. Findings from the bench translate to the bedside and vice versa. Clinical efficacy and effectiveness trials translate into improved patient care, and patient-centered outcomes and patient stakeholders drive the research questions of comparative effectiveness. Jared Diamond stated: “Science is often misrepresented as the body of knowledge acquired by performing replicated controlled experiments in the laboratory. Actually science is something broader: the acquisition of reliable knowledge about the world.” [5] Thus, surgical research is firmly committed to solving real world problems. Nonetheless, important lessons can still be learned from the choices that societies make based on their core values, which are the basic or essential beliefs of a person or group; the core values of a society are reflected in its brand. In 2011, AAS went through a rebranding campaign led by immediate Past President Melina Kibbe. At the time, the design company asked the society to consider several questions. Who is AAS? What are the society’s personality and values? The AAS’ reply was that “AAS is the one inclusive and dynamic international association focused on delivering leading benefits and opportunities to research-based academic surgeons” (Kibbe, personal communication from Brierton Design). The AAS’ personality was described as: dynamic, active, energetic, vibrant, robust, helpful, mentoring, warm, accessible, available, open, inviting, inclusive, and .smart! As a reflection of those traits, the AAS logo now represents open doors (Fig. 1); the AAS strives to open doors for current and future academic surgeons.

3. Long-term planning based on AAS’ core values These are several of AAS’ core values that should be considered in long-term planning for the society: 1 Promotion is the act of furthering the growth or development of something [6]. The AAS seeks to promote “a shared vision of research and academic pursuits through the exchange of ideas between senior surgical residents, junior faculty, and established academic surgical professors.” [7] The AAS promotes academic surgery through

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There are multiple other core values of our society, but these are the ones on which our past year has been focused.

4. Promoting diversity and inclusivity: redefining academic surgery

Fig. 1 e The AAS logo represents open doors; listed on each panel is one of AAS’ core values that guide long-term planning.

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the Academic Surgical Congress (ASC), national and international courses, grant opportunities provided by the AAS Foundation and Elsevier, networking opportunities, early leadership in the society, and mentoring programs. Diversity and inclusivity go hand in hand. The AAS has become more diverse and more inclusive over time; we are a diverse group in terms of gender, race or ethnicity, surgical specialty, level of training, type of research, and country of origin. Scientific excellence is a core value of the AAS that is endorsed at the fundamentals of research course and at its international courses. Furthermore, the AAS celebrates high quality research with multiple awards throughout the year and at the ASC. Innovation is the act or process of introducing new ideas, devices, or methods [8]. This year’s presidential session is dedicated to innovation. Collaboration is another core value. The AAS has developed sustainable and long-term collaborations with multiple sister societies such as the Surgical Outcomes Club and our international partners such as the West African College of Surgeons, the Colombian Surgical Association, the Taiwan Surgical Association, and the Royal Australasian College of Surgeons. The ASC is a result of our collaboration with the SUS. The AAS has also promoted networking and collaboration between mentors and mentees and between researchers from different laboratories. Mentorship is a shared value between all AAS members. At a recent Executive Council retreat, everyone was asked to describe a recent experience, which reminded him or her why they became academic surgeons. Not a single person described his or her own accomplishment, but rather everyone described the accomplishments of one or more mentees.

In considering these core values, how can we ensure the success of the AAS? How can we balance the pursuits of the ivory tower with the demands of the real world? Over the past year, the AAS has formed five working groups that are embracing these core values and working to promote them. These working groups are all interconnected; by opening the innermost doors as shown on our logo, further doors are opened. As a society, the AAS promotes academic pursuits, but what does that mean? Traditionally, an academic surgeon was defined as a clinician, a researcher, and an educator. These three roles that comprise the “triple threat” have been compared with the legs of a tripod, with the implication that equal weights should be placed on each. If a leg is added for administrator, then the surgeon might be considered a quadruple threat. However, is this an attainable or desirable goal for future surgeons? In a piece for the AAS blog, The Academic Surgeon, James Wu, a general surgery resident at UCLA Medical Center, described the angst that young surgical trainees have in pursuing an academic career. He wrote: “An academic surgical career demands compromise and imperfection in some areadeducation, research, or clinical practice. The struggle to maintain excellence in all facets appears to be a major source of stress.” [9] If this is how the next generation feels, is the traditional model of an academic surgeon broken? Is perfection necessary for happiness? If so, how should perfect be defined? If not, what is necessary? Malcolm Gladwell, author of The Tipping Point and Blink, describes in his TED talk titled “Choice, happiness and spaghetti sauce” the quest by Pepsi to find the perfect diet soft drink [10]. Expecting a normal distribution of responses based on sweetness, the consultant that Pepsi hired was puzzled by the scattered nature of the actual data until he had a breakthrough. The question should not have been “What is the perfect Pepsi?” but “What are the perfect Pepsis?”. As a result, we now have regular Pepsi, diet Pepsi, Pepsi Max, Pepsi Next, and Throwback Pepsi. Should there be a similar variety and selection in types of academic surgeons? The idea that there should be different types of academic surgeons is not new. The first AAS blog piece written by Amalia Cochran (AAS Representative to the Association for Surgical Education) addresses the issue of the changing paradigm for academic surgery. She describes alternative types of research to basic sciencedoutcomes, education, and global health. Furthermore, she states: “My take-home message for a junior resident or medical student contemplating the concept of academic surgery is that it is a career increasingly defined by those who are in it, with expanding acceptance of alternative forms of academic activity.” [11] Alternative types of academic surgeons extend beyond the types of research performed. In his talk on “What is a career in academic surgery?” for the AAS and Royal Australasian College of Surgeons (RACS) Developing a Career in Academic

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Surgery course, Professor John Windsor who is the Past Chairman of the Section of Academic Surgery stated that an academic surgeon is a surgeon who has chosen, in addition to practice excellent clinical care, to acquire specific training and experience in research and/or education and/or leadership to make these dimensions a significant part of their career [12]. He then went on to suggest that it is not necessary to excel in all of these dimensions or to even excel in the same dimensions throughout a career. If we expand the types of academic surgeons beyond just those that do research to those that educate, innovate, or administrate but not necessarily perform research, then how should we measure their success? An academic career focused on research has metrics that include numbers of publications and grants. How do you measure the impact of an academic surgeon in these other areas? AAS currently has a working group focused on promotion across the spectrum of academic surgery from medical student to professor. This includes developing tools and resources for negotiation and for promotion. An important task for this working group is to determine the metrics by which one might be judged an outstanding clinician or an outstanding innovator. The Fall AAS Career Development Course includes a lecture on the Educator Portfolio. Why not a QI portfolio? Should we not have metrics for all types of academic surgical portfolios? In addition, AAS provides mentors and role models for trainees in terms of research, why not for other types of academic surgery? Redefining academic surgery and providing tools and guidance for future trainees navigating this course are aligned with the AAS’ core values of diversity, inclusivity, and promotion.

5. Promoting scientific excellence and innovation: enabling the collective mind How can opening the doors and increasing inclusivity and diversity promote scientific excellence and innovation? Research and scientific excellence in research always has been and always will be fundamental to academic surgery. As members of the AAS and SUS and as attendees of the ASC, we value research highly. In his 1980 AAS Presidential Address, Dr Creighton Wright stated: “Research is the marker of the Association for Academic Surgery, the greatest part of our program, the title of our journal, a favorite subject of our conversation, and part of the fun of our lives.” [4] Without high quality, methodologically sound, replicable, and relevant research, we could not advance our discipline to improve patient care. By allowing alternative forms of academic surgery, not just research, but innovation will thrive. Matt Ridley, author of The Rational Optimist: How Prosperity Evolves, describes in his TED talk what happens “When ideas have sex” [13]. He describes how specialization encourages innovation. He asks the question, how much would it cost you for 1 h of light if you had to start from scratch? How long would it take? Nowadays, it would only take 0.5 s of work to afford 1 h of light. No single person knows how to construct a light bulb today from scratch, but it is the collective mind that allows us to have these products. In fact, he states in a related essay that

“Specialization is the means by which exchange encourages innovation: In getting better at making your product or delivering your service, you come up with new tools.” [14] Rather than each prehistoric man making each and every tool, they saved time by only making one tool and this efficiency resulted in prosperity. In an era where there are many competing interests for academic surgeons’ time, such efficiency only makes sense. For example, not everyone necessarily needs to conduct basic science research; rather, by optimizing resources and by encouraging specialization, only the best basic science will be performed. Thus, the collective mind promotes innovation and progress. TED talks are an example of what happens when you bring people and ideas together from different disciplines. TED stands for technology, entertainment, and designdthe three disciplines originally brought together in a conference in 1984 to share ideas. Now, TED talks include content on science, business, the arts, technology, and global issuesdall of which despite seeming glaringly different, share common themes. TED talks have come to represent the best talks given by the world’s most innovative thinkers in 18 min, and these are widely available to the world as “TED: Ideas Worth Spreading.” [15] The AAS Presidential Session this afternoon is devoted to five similarly styled talks on innovation in translational and clinical research, surgical education, social media, and patient care. If successful, this format could be used to have top surgeon scientists give talks about their research and to have specialists in other related fields such as bioinformatics or statistics or epidemiology give talks as well. This would encourage surgeons to come to the ASC to hear the best scientists talk about their best science. The ASC is also an example of where different disciplines come together to share ideas. Although many societies are housed under the umbrella of specific subspecialties, the AAS and SUS are societies whose membership is bound together by a common passion for academic surgery. Although there are doomsayers who have predicted the extinction of meetings [16], the ASC has only gotten larger over time. Registration has gone up each year with a 30% increase between 2009 and 2012. The ASC has representation all along the spectrum from high school student to senior professor and from multiple subspecialties including neurosurgery and urology. There are even attendees whose primary interest is outside of clinical caredepidemiology, statistics and computing, health economics, and laboratory animal medicine! Thus, the ASC promotes scientific excellence and innovation by developing connections and enabling the collective mind.

6. Promoting collaboration and mentorship: harnessing technology We need to harness technology if we are to advance our science and to promote collaboration and mentorship worldwide. With so many attendees at the ASC, how can we find those with similar interests? How can we disseminate our research findings to those with whom we might collaborate? The introduction of the quickshot presentation in place of posters forced attendees to pare down their research findings into 3 min and five slides or less. Although this allows more

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Fig. 2 e The impact of social media is demonstrated by the exponential increase in impressions resulting from a small number of Twitter users at the 2013 Academic Surgical Congress.

people to present, it also makes it more challenging to find other researchers with whom to network. What if instead of 3 min you only had 30 s to describe your research? Last year, the California Institute for Regenerative Medicine launched a contest for the best elevator pitch whereby scientists were allowed to either film on site or send in a description of their research in 30 s [17]. The challenge was not only to provide a concise description of their research, but also to do so in a way that would be understood by the lay public. What if you could give your equivalent of an elevator speech without video? Ben Nwomeh, one of the AAS’ twitter team, suggests that for every abstract accepted for the 2015 meeting, the lead authors should submit one or two statements that best capture the message of the presentation. The message should leave the attendees hungry for more information and cannot exceed 120 characters; the Twitter team would then use these statements to deliver the appropriate tweets during the meeting. This would be completely innovative, as no other meeting has done this. Despite the explosion of social media, many AAS members remain skeptical about its utility and its impact. Amalia Cochran and the Twitter team looked at the impact of Tweets from last year’s Academic Surgical Congress who used the distinct hashtag #2013ASC. There were 58 distinct individuals who used this hashtag. Among 434 total tweets, 288 were original. These tweets reached 32,111 independent viewers and left 474,776 impressions (Fig. 2) [18]. Twitter not only significantly expands one’s reach but also is not limited by geographical borders. The internet, social media, and globalization will only further enable the collective mind and progress. So, why in the era of this technology should we still have meetings? The society should think about restructuring interactions at these meetings. Perhaps, rather than having five people present their research on predictors of readmissions after cancer surgery using different datasets, there should be small group breakout sessions where those researchers discuss how to make advances in mitigating these risk factors, in answering unsolved questions about readmissions, and in reducing readmissions across multiple settings. Perhaps just

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as one submits names of recommended reviewers for journal articles, one could submit the names of three people with whom one would like to sit at a roundtable. The AAS has a task force focused on developing such innovative methods for disseminating information. Mentoring has been a focus of prior hot topic sessions. At the ASC, the AAS has a student mentoring session and at the fall courses, there are mentoring sessions for trainees and junior faculty. The ASC should expand the opportunities for interactions between mentors and mentees. The AAS offers courses in surgical research and career development, and the SUS offers a course in mid-career development. Why not a course in mentoring? What about providing tools for mentoringepartnership agreements and progress report templates? There should also be metrics for evaluating the reach, effectiveness, and adoption of mentoring programs [19]. The AAS provides grants and awards for trainees and faculty, what about for mentors? Mentorship programs should be formed at the local level and then interact on national and international levels [20]. Technology can then be used to support these mentoring initiatives. The AAS Global Affairs Committee and the working group on communication and innovation as well as on international outreach are developing methods for using technology to enhance collaboration and mentorship across the world. Sanjay Krishnaswami and Mamta Swaroop, co-chairs of the AAS Global Affairs Committee, recently presented at the World Congress of Surgery, Obstetrics, Trauma and Anesthesia this past year on using technology to connect educational initiatives across the world. Thus, the core values of collaboration and mentoring can be further promoted both in people at the meetings and courses, but also via the Internet nationally and internationally through technology.

7. Promoting resilience: the key to our success Are these core values sufficient to ensure success? Let us reconsider the story of Easter Island and the question of whether academic surgery is doomed to collapse; perhaps part of the equation is how you define success. In rebuttal to Jared Diamond, several scholars published a series of essays in a book entitled Questioning Collapse: Human Resilience, Ecological Vulnerability, and the Aftermath of Empire. In the book, one scholar offers evidence that suggests that Easter Island did not collapse as a result of deforestation and ecocide, but rather that in actuality, the inhabitants survived adversities largely brought on by the outside world. Furthermore, descendants of the ancestral people are thriving on the island today. “The real story here is one of human ingenuity and success that lasted more than 500 y on one of the world’s most remote human outposts.” [21] Thus, the story of Easter Island is one of resilience rather than one of collapse.

8.

Conclusions

In summary, there are several lessons to be learned. The first lesson is that passion is what drives the journey; without it,

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the rewards themselves are much less meaningful. The second lesson is that as a society and as individuals, we must have a strong sense of our core values, as they are what guide our journey. The third lesson is that success is how you define it. But just as in research, we must measure our outcomes; we must decide by what metrics we will define our success as individuals, as a society, and as a discipline. The last lesson is that individuals and societies survive by being resilient in the face of adversitydby being able to adapt and to confront challenges. The title of this talk suggested that there is a battle between the real world against the ivory tower or academic surgery; based on the economic and political forces of the real world, this battle may seem hopeless. But in fact, we as a society and as academic surgeons are resilientdable to adapt to and confront challenges; like Fermat last theorem, survival in today’s changing world is not an unsolvable challenge. Because of an impassioned membership and strong core values that guide our leadership, the Association for Academic Surgery has a bright and sustainable future ahead of us.

9.

Thank you

Thank you to the AAS for allowing me the privilege of serving as president this past year; it has truly been an honor and a privilege. The AAS will always remain near and dear to my heart. Ultimately, it is the alignment of the AAS’ core values with my own that drew me to the organization. I would like to thank all of those people in my life that helped me to develop my own set of core values along the way and to give voice to those values; it is to them that I owe my successes! My mother and my father, Mark and Lenore Kao, are here today from Chicago, and my sister, Christina Kao, traveled here from Houston. I would like to thank all of them for their support, but particularly my mother and my father for all of the sacrifices that they made for me and for instilling in me a strong work ethic and a passion for learning. They have taught me so much, but in particular, I learned from them the core values of hard work, life-long learning, and dedication to family. I have had many role models for leadership along the way. Dr Carlos Pellegrini was my chairman during residency and fellowship at the University of Washington, and he has been an advocate, a role model, and an inspiration for me. Dr Richard Andrassy is my current chairman at the University of Texas Health Science Center at Houston (UT Health), and he has supported my career and my choices along the way; I have never doubted that he has my best interests always at heart. Dr Herb Chen was one of many and one of the first to encourage me to join the AAS. He appointed me to my first leadership position within the society as Co-Chair of the Education Committee. His impact on the society is still evident today through his many mentees who serve on the council and on committees. Dr. Scott LeMaire is the past president of the AAS; it was truly amazing to work with him as his Secretary. He led by example in terms of professionalism, integrity, and vision. Dr Melina Kibbe is the immediate past president of the AAS; she has taught me to lead with passion, energy, and optimism.

Similarly, I have had many role models for mentorship along the way. Dr David Mercer took a chance on me and hired me for my first faculty job at LBJ General Hospital. He mentored me through the transition to attending physician and through my career development award, for which I will always be grateful. Dr Kevin Lally has been my mentor for over 10 y; he has previously received an award for mentoring. His honest and practical feedback has helped me to navigate my career. Dr Jon Tyson, who is a neonatologist and the Director of the Center for Clinical Research and Evidence-Based Medicine at the UT Health has nurtured me as a researcher and provided me with the methodological skills necessary to succeed. He has been selfless in his giving of time, funds, and support. Last but not least, my colleagues on the AAS Executive Councils have made my job easy. In particular, I would like to thank the current officers: Tim Pawlik, President-Elect; Eric Kimchi, Treasurer; Justin Dimick, Secretary; and Caprice Greenberg, Recorder. They have all taught me about teamwork, collaboration, collegiality, and acceptance. Thank you so much.

Disclosure The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

references

[1] Andrew Wiles on Solving Fermat. PBS, 2000. (Accessed February 10, 2014, at http://www.pbs.org/wgbh/nova/ physics/andrew-wiles-fermat.html). [2] Conter RL. The death of academic surgery? J Surg Res 1998; 76:1. [3] Fonkalsrud EW. Presidential address. Winds of change in academic surgery. J Surg Res 1973;14:81. [4] Wright CB. Presidential address. Academic surgery: past and prologue. J Surg Res 1981;30:191. [5] Diamond J. Collapse: how societies choose to fail or succeed. New York, NY: Penguin Group; 2005. [6] Promotion. Merriam-Webster. (Accessed February 10, 2014, at http://www.merriam-webster.com/dictionary/promotion). [7] Who Are We? (Accessed February 10, 2014, at http://www. aasurg.org/about.php). [8] Innovation. Merriam-Webster. (Accessed February 10, 2014, at http://www.merriam-webster.com/dictionary/ innovation). [9] Wu J. Reflections on the AAS fall courses. In: The Academic Surgeon: Association for Academic Surgery; 2013. Retrieved from http://www.aasurg.org/blog/reflections-aas-fallcourses/. [10] Gladwell M. Malcolm Gladwell: choice, happiness and spaghetti sauce [Video]; 2004. Retrieved from http://www. ted.com/talks/malcolm_gladwell_on_spaghetti_sauce.html. [11] Cochran A. I’m just a medical student. What’s this “Academic Surgery” business? In: The Academic Surgeon: Association for Academic Surgery; 2013. Retrieved from http://www.aasurg.org/blog/medical-student-academicsurgery/. [12] Windsor J. What is a career in academic surgery?. In: Developing a career in academic surgery. Auckland, New

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Zealand: Association for Academic Surgery/Royal Australsian College of Surgeons; 2013. Ridley M. Matt Ridley: when ideas have sex [video]; 2010. Retrieved from http://www.ted.com/talks/matt_ridley_ when_ideas_have_sex.html. Ridley M. Humans: why they triumphed. The Wall Street J; 2010. TED: Ideas worth spreading. (Accessed February 10, 2014, at http://www.ted.com/). The slow death of scientific meetings. By Caveman. J Cell Sci 2000;113(Pt 22):3883. Stem cell elevator pitch challenge. California’s Stem Cell Agency: California Institute for Regenerative Medicine. (Accessed February 10, 2014, at http://www.cirm.ca.gov/ourfunding/stem-cell-elevator-pitch-challenge).

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[18] Cochran A, Kao L, Gusani N, Suliburk J, Nwomeh B. Use of twitter to document the Academic Surgical Congress: a pilot experience. Journal of Surgical Research; 2014 (in press). [19] Beech BM, Calles-Escandon J, Hairston KG, Langdon SE, Latham-Sadler BA, Bell RA. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature. Academic medicine: journal of the Association of American Medical Colleges 2013;88:541. [20] Patel VM, Warren O, Ahmed K, et al. How can we build mentorship in surgeons of the future? ANZ journal of surgery 2011;81:418. [21] Hunt T, Lipo CP. Questioning collapse: human resilience, ecological vulnerability, and the aftermath of Empire. 1 ed. New York, NY: Cambridge University Press; 2009.

Real world versus ivory tower: the challenge for academic surgery.

Academic surgeons increasingly must balance scientific pursuits with the demands of maintaining a clinical practice. This article describes the core v...
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