Surgical Education’s 100 Most Cited Articles: A Bibliometric Analysis

Background

Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed.

Methods

Thomson Reuters Web of Science was interrogated using the keyword search terms “surgery” and (“learning” or “skills” or “competence” or “assessment” or “training” or “procedure-based assessments” or “performance” or “technical skills” or “curriculum” or “education” or “mentoring”] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin.

Results

A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40).

Conclusion

Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education.

Introduction

The development of surgical education and published works has a long and distinguished history, originating from Galen of Pergamon (AD 131-201), a prominent Greek physician, surgeon, and philosopher in the Roman Empire, and arguably the most accomplished of all medical researchers of antiquity. His theories dominated western medical science for more than 1500 years and his anatomical reports were a mainstay of medieval physicians’ university curricula, with medical students continuing to study his writings well into the 19th century.¹

The western world’s most senior surgical college, in 1505, the surgeons and barbers of Edinburgh, now known as Royal College of Surgeons of Edinburgh, UK, was formally incorporated as a Craft of the Burgh,² when a seal of cause (charter of privileges) was granted by the town council of Edinburgh, conferring certain privileges and imposing certain crucial duties, the most important of these being that every master surgeon should have full knowledge of anatomy and surgical procedures; that all apprentices be literate; and that this knowledge be thoroughly tested at the apprenticeship end. All clauses remain relevant to contemporary surgical practice, and with the development of formal training programs, the development of published research works has become allied with successful training progression and more recently associated with assessment of competence progression.

The standard of published works can be rated by means of citation analysis (ranking and evaluating an article or journal related to the number of citations received), thereby establishing a citation rank list, a surrogate marker of quality, which identifies the most influential publications.³ Several reports have used citation rank analysis to identify the most influential articles in specialist fields, including trauma and orthopedic surgery,⁴ plastic surgery,⁵ general surgery,⁶ urology,⁷ and oncology.8, 9 Yet at the time of writing, only 1 report exists regarding the most influential articles in surgical education by Wohlauer, describing the 20 most cited publications between 2002 and 2012.¹⁰ The aim of this study was to amplify the above and determine the topics and specifically the studies that had been most cited in the arena of surgical education by means of a bibliometric analysis of the 100 most cited articles over the past 100 years.