Re: Goel A. Research training during residency. Indian J Urol 2017;33:257-8.

Dear Editor,

With great interest, I read the editorial on research training during residency published in the Indian Journal of Urology.[1] The article succinctly summarizes the state of research training in India and also puts the contribution of Indians to world literature on this subject into the perspective of residency training.

While the excellent article addresses an important topic, there are a few facts that need correction. While mentioning Indian work on chyluria, a significant work on povidone-iodine instillation published in the British Journal of Urology in 2004 was omitted.[2] Second, the list of 100 most cited publications has been updated in 2013.[3] The revised list has no Indian publications. However, the assumption that only highly cited research is “novel” might be flawed. A “novel” concept that is relevant to a niche audience[4] might not get as many citations as a manuscript with a shorter title[5] or a more generalizable (interesting) cross-specialty topic.[6]

In addition, there are a few aspects that deserve further consideration. While the editorial comprehensively enumerates various problems ailing the system, the solution is left mostly to “deep thinking” by the resident. To attribute the failure of a system to residency training and mentors alone would be an oversimplification. A more practical narrative could focus on the need for continuous and high-quality data to be maintained by the institution. Instead of being project-specific, institutional databases are disease-specific, maintained, and retrospectively analyzed by residents. This culture of data keeping would foster a continued environment of research, rather than the singular 2-year projects as described by the author.

In addition to this, there has been an increasing use of prospective multi-institutional databases in recent urological literature. These can be retrospectively analyzed at the national[7] or international level[8], emphasizing the need for collaboration and data sharing. Due to higher numbers, these studies are adequately powered and are more likely to be cited.

The prospective studies, on the other hand, must be carefully designed, and principal investigator initiated. The “concrete experience” in Kolb's cycle of learning is probably the right starting point for prospective studies.

In this context, it is also apt to mention that the entry criteria to residency programs in the country are mostly similar, and the cohort of residents getting residency in a particular year is similar in intellect and qualifications. However, there may be program-to-program, as well as within-program variation in both clinical exposure and research, and most of the variations in research mentioned by the author come from the program rather than the resident. A surgeon is as good as his instruments. In the same way, a resident is as good as the environment he is taught in. This editorial is very timely, addresses the elephant in the room, and I hope it will lead to more attention on this important topic.