Publication involvement of plastic surgery residents in accredited services : A 10-year comparative analysis

Article received December 26, 2014. Article accepted April 22, 2015. Introduction: Conducting research and publishing articles during residency are not mandatory yet. However, these are shown to be necessary during training. This study aimed to evaluate the participation of resident physicians from services accredited by the Brazilian Society of Plastic Surgery in the publication of articles in the Brazilian Journal of Plastic Surgery by analyzing how they have evolved over a period of 10 years. Methods: We evaluated articles published in the Brazilian Journal of Plastic Surgery between 2003 and 2012, excluding editorial, letter, message, erratum and acknowledgment articles. We also evaluated data regarding sex, demographic region, type of work, number of papers published with the participation of residents, mean number of residents per publication, subject area, and educational institution. Results: We identified 204 articles, of which 53 were published between 2003 and 2007, and 151 were published between 2008 and 2012. The most common subject was body contour, accounting for 95.1% of descriptive studies. Most of the authors were not affiliated with higher institutions (54.4%), and the residents from the southeast region were most active participants. On comparing different periods, we observed an increase in the number of residents as authors and in the participation of residents. The number of articles increased significantly in all regions of the country, except in the south. Conclusion: The participation of residents in the publication of scientific articles that were published in the last 5 years in the southeast, northeast, and midwest regions has increased. The training structure for resident physicians should be improved to increase scientific publication in both, quantitative and qualitative aspects. ■ ABSTRACT


INTRODUCTION
Brazilian services of medical residency are validated by the Ministry of Education and Brazilian Society of Plastic Surgery (BSPS).During medical training in plastic surgery, physicians are provided the opportunities to acquire clinical and surgical knowledge from the initial history of the patient to postoperative follow-up, to study and gain qualification in different surgical techniques, to develop skills in detecting patients who are candidates for surgery, to gain efficaciousness in case of emergency care and plastic surgery emergency, and to develop research activities [1][2][3] .
Performing research and publishing articles during the period of medical residency has not been made mandatory till date.However, in many countries, this has been shown to be necessary during the evolution of the plastic surgeon for the improvement and evolution of evidence-based medicine.

OBJECTIVE
To perform multivariate statistical evaluation regarding the participation of medical residents from services recognized by the BSPS in the publication of articles in the Brazilian Journal of Plastic Surgery by assessing their evolution over a period of 10 years.

METHODS
We selected articles published in the Brazilian Journal of Plastic Surgery from 2003 to 2012, excluding editorial, letter, message, debates, errata, and acknowledgment articles.The study included articles from plastic surgery services that are currently accredited by the BSPS and involved the participation of residents, interns, and aspirant members in plastic surgery.
We evaluated data such as sex, demographic region of accredited services, type of work, number of papers published with the participation of residents, mean number of residents per publication, subject area of the article, and Introdução: O desenvolvimento de pesquisas e a publicação de artigos durante o período de residência médica ainda não é obrigatório, porém tem sido evidenciada a sua necessidade durante a formação.Este estudo tem como objetivo fazer uma avaliação com relação à participação de médicos residentes dos serviços reconhecidos pela SBCP na publicação de artigos na Revista Brasileira de Cirurgia Plástica, comparando a evolução destes em um período de
The authors were affiliated with several institutions that were categorized as institutions of higher education (n = 93 articles, 45.6%) and non-teaching institutions (n = 111 articles, 54.4%).Of the total number of articles (n = 204), 138 (67.6%) were related to the type of reconstructive surgery; 50 (24.5%),to aesthetic procedures; and 16 (7.8%),to others.The region of Brazil with the highest number of articles published (2003-2012) was the southeast region (158-77.5%),whereas the lowest was the south (10-4.9%;Table 1).In the first and second periods evaluated, the southeast region remained the area with the highest proportion of articles published (p ≤ 0.001; Table 2).Regarding the participation of the residents per article, 88 articles (43.1%) involved the participation of only one resident, of whom 61 (69.3%) were men; 58 articles (28.4%), the participation of 2 residents, of whom 56 (96.4%) were men; 30 articles (14.7%), the participation of 3 residents, of whom 30 (85.5%) were men; and 28 articles (13.7%), the participation of 4 or more residents, all of whom were men.The mean number of resident participations per article was 2.11 ± 1.47.The number of resident authors increased from 4 (6.8%) in the first period evaluated to 55 (93.2%) in the second period evaluated (p ≤ 0.001; Figure 1).The number of articles published increased proportionally in all of the regions, except the south, where the increase was not significant (Figure 2).The participation of residents in the publication of articles and the number of articles increased significantly (p ≤ 0.001).In the evaluation of the entire study period, no difference was observed in the participation of different institutions over the period of 10 years.The number of articles from higher education institutions was 93 (45.6%), and that of articles from non-teaching institutions was 111 (54.4%; c 2 = 1.588, p = 0.208; Table 3).
The number of published articles from educational institutions increased from 29 in the first period to 64 in the second period (p ≤ 0.001).The number of published articles from non-exclusivelyteaching institutions also increased from 24 in the first period to 87 in the second period (p ≤ 0.001; Table 3).
Among the authors of all of the articles, 97 (54.27%) were affiliated with higher education institutions (public or private) and 130 (57.3%) were   affiliated with hospitals that did not present the characteristics necessary to be considered a highereducation institution.By using the Wilcoxon test for related samples (p ≤ 0.001), a significant increase in the production rate was observed in all of the regions, from the first to the second period.The region with the lowest increase in production was the southern area, whereas that with the highest increase was the northeast region, followed by the midwest.By using a coefficient that divided the number of publications by the number of accredited services in the region, we obtained an increased production in all of the regions.However, only the southern region presented an increase that was less than 1 (Table 4).

DISCUSSION
The current total number of services of medical residency in plastic surgery that are accredited by the BSPS is 84.The evolution of residents as medical specialists should be guided by the best ethical, technical, and scientific rigor [4][5][6] .The Brazilian Journal of Plastic Surgery is the most accessible tool for plastic surgery residents to share their scientific knowledge and contribute to the growth and qualification of residents in this service.The results of this study show that most of the residents involved in publishing articles were male and resided in the southeast region of Brazil.Their main area of study was facial and body contours, with reconstructive orientation, regardless of whether this is a service of higher education or not.
The fact that the male sex was more prevalent than the female sex among the residents demonstrates that changes regarding gender equalization in the course of medicine have not been extended yet to the surgical specialty 7 .Medical residency services are concentrated in the southeast region.This explains why the highest number of works was published by residents from this region.
The articles published were mainly descriptive, related to reconstruction, and addressing topics of facial and body contours.The fact that most articles are descriptive reflects the need for greater incentives to complete works with more elaborate scientific evidence, such as case studies or randomized trials.However, the limitation referring to the training period, which hindered the realization and completion of this work within 3 years, should be emphasized.
The increased participation of residents, as authors or coauthors, was observed in all of the regions.We also observed an increase in the number of works published by residents from the northeast, midwest, and southeast regions.However, no such increase was observed in the southern region during the period evaluated.The increase in the number of published works was significant, although far from the existing potential.If we consider that each resident should publish one study per year, approximately 262 articles would be published per year, taking into account 3 residents per the 84 services currently existing.For the survey in this study, only 151 articles were published in the last 5 years.Considering the potential for 5 years, 1,310 articles should have been published, suggesting that only 12% of the estimated potential was achieved.

Figure 1 .
Figure 1.Distribution of the number of articles published according to the Brazilian regions and the periods evaluated (Goiânia, 2014).

Figure 2 .
Figure 2. Distribution of the number of residents per item according to the period evaluated (Goiânia, 2014).

Table 1 .
Distribution of the published articles according to Brazilian geographic regions (2003-2012).

Table 3 .
Distribution of the number and percentage of articles published according to the period evaluated and the type of institution.
p = 0.082 (between institutions in both periods).

Table 4 .
Distribution of production indexes* according to the Brazilian regions in the 2 periods.