Defence of a thesis at Erasmus University, Rotterdam: a model of research and publishing by a young surgeon
On 7th December 2005 I had the privilege of being one of a dozen academics before whom Dr Özcan Birim stood to defend his PhD thesis. We Court of Examiners processed in our full regalia of academic gowns and hoods; exactly an hour later at the sound of a gong and the words “Hora est!” we processed out again to reach our verdict. In the intervening 60 minutes Birim introduced and faced questioning on the research contained in his thesis, a bound volume that will grace many libraries’ shelves. It contains eight first author papers, most in print, some in press, and other chapters giving introductory context and conclusions. In a steeply raked lecture theatre in Erasmus University in Rotterdam young Dr Birim stood before us, flanked by two young colleagues, all three in white tie and tails. The theatre was open to the public for the occasion and contained many members of the hospital, university and importantly, Özcan’s parents and family.
It caused me to reflect again (for I have done many times before) on the purpose behind a surgeon in training devoting time to research and publication, and in some instances, earning a further postgraduate qualification for research. Very few go on to become academics and many will never write a paper or do research again. Why do they do it? I can identify four quite separable objectives and to let you understand where this is all heading, I will state now that, in my view, the way they do it in Holland achieves all four - and they do it in style.
1. Appropriate personal development for the tyro surgeon.
2. A real contribution to knew knowledge.
3. A measure of achievement.
4. A rite of passage.
It is believed that a period in original research, as opposed taught courses, develops ability to appropriately modify practice in the light of new knowledge. It equips us for an unknown but inevitably changing future. Some still advocate time in the animal laboratory but in those far off days when it was the norm for every surgical department ot run an animal laboratory, biological knowledge and technical skills overlapped between animal and clinical experimentation. Birim’s work is in lung cancer. There is no animal model for its surgical management. His thesis comprises extensive literature reviews, statistical analysis of risk factors and comorbidity, life table, survival and meta-analysis. These are the vocabulary and skill of modern health care research and he has acquired them. This satisfies my first requirement – it is appropriate personal development.
To make an important contribution to knowledge (my second objective) would indeed be an achievement during a brief spell in a modern basic science laboratory. The individual’s contribution is likely to be a small part of a major project. On the other hand, performing clinical studies and undertaking secondary research (systematic reviewing and meta-analysis) cannot be done without the background knowledge that a clinician brings and it changes practice for the better immediately. Birim’s book adds to the knowledge we use to treat lung cancer. He has added more than he could have done in equivalent time with a young surgeon’s toolkit doing Western blotting in knock-out mice.
It is a competitive world. We have plenty of applicants competing for posts. We need objective ways for individuals to distinguish themselves. In Britain we still produce a thesis of our research work. John Kirklin used to decry the practice, arguing that peer reviewed papers were the proper currency of research endeavour. Birim has his first author peer reviewed papers published in international journals and he has them bound in a book. Two-for-one. How smart is that? My third objective achieved.
Finally, the rite of passage. In Britain we examine a thesis behind closed doors: a drab process which is all too often an anticlimax after much hard work. Defending your thesis in front of your parents, family, friends, compadres, and your surgical chiefs certainly qualifies as a rite of passage. It was great day for Özcan Birim.