If Surgical Research Is So Important, Why Are We All Doing It at 1 A.M. in Our Pyjamas?

There’s a particular kind of despair that only surgical trainees know. Not the 4 a.m. trauma call. Not the list-overrunning-by-six-hours, I wonder who collected my child from nursery despair. Not even the “your consultant is scrubbed and waiting and you are definitely not ready” despair. No — I’m talking about the despair of mandatory research.

Research, in theory, is a noble pursuit. It’s how we advance the field. It’s how we question dogma. It’s how we push the scalpel forward. But somewhere along the way, research in surgical training mutated into something else entirely: a strange, ritualised box-ticking exercise, performed mostly at midnight on your “days off”, fuelled by cold coffee and existential dread.

Every trainee knows the dance. You finish a 60-hour week, collapse onto the sofa, and just as you’re beginning to resemble a human being again, you remember you still haven’t updated the spreadsheet for that “collaborative” audit you were conscripted into three months ago. The one that was supposed to take two hours. The one that now stalks your dreams like a benign but insistent polyp.

And then there’s the power dynamic: your educational supervisor holds the keys to your placement sign-off, study leave, and sometimes even funding. One suggestion from them can feel less like guidance and more like a mandate you cannot refuse — even if the research makes no sense. For example, a colorectal consultant recently asked me to do a study on the use of TEVARs. Neither they nor I had ever performed one. Neither of us had meaningful experience, and we had no dataset that added anything new to the multiple studies already published. I dutifully wrote the article, emailed the final draft multiple times, and received no reply — except a vague verbal “we’re happy with it.” Assuming they had nothing further to contribute, I submitted the article to a journal. Within an hour, a furious email arrived: they were concerned that submitting it without their explicit knowledge could be a GMC probity issue! A paper that I had done all the work on, with zero contribution from them, suddenly became a professional landmine overnight.

Another supervisor promised me ethical approval for a study on a Bluetooth-connected device to monitor patients’ vitals at home post-operatively. I spent countless evenings and weekends collecting data, running analyses, and drafting the manuscript. Later I discovered he hadn’t even prepared a case to submit to the hospital’s ethics committee. All that work, entirely voluntary, had been effectively wasted — and yet it was framed as a “mandatory” contribution for my portfolio.

Because if you don’t submit it? If you don’t generate something — anything — with a p-value and a graph? Then you don’t progress. It doesn’t matter if the project asks an uninteresting question. It doesn’t matter if the methodology is held together with surgical tape and hope. It doesn’t matter that the dataset is so anaemic it should be prescribed iron. What matters is that you can say: “I have produced research.” Never mind that the paper will quietly sink into the digital void, cited only by one automated bot and a confused medical student seven years from now. Never mind that none of it remotely improves patient care. Never mind that none of it resembles actual academic curiosity. The system demands that we generate volume, not value.

The irony is almost surgical in its precision: We enter a profession built on evidence, yet we’re encouraged — no, required — to produce the very evidence we would never actually use. I sometimes wonder if historians will look back and examine our era of surgical training the way anthropologists study obscure tribal rituals: “Here we observe the junior registrar, forced to collect irrelevant data in the dark hours of the night in order to appease the ARCP Deities. Note the glazed eyes. Note the coffee cup fused permanently to the hand.”

The pressure is constant. Every ARCP, every interview, every portfolio review — there’s the same quiet, menacing reminder: “And what research have you done this year?” Never mind the actual job. Never mind the lives held between bleeps and theatre lists. Never mind the fact that most of us are just trying to survive long enough to learn our craft with some semblance of competence.

What frustrates me most is that it doesn’t have to be like this. Surgery actually needs good research. We need better trials. We need better evidence. We need people who understand statistics rather than people who open SPSS like a cursed grimoire. But instead of nurturing genuine inquiry, we have turned trainees into overworked data-entry machines producing weak, low-yield studies that pad CVs but rarely illuminate anything.

Imagine if we were supported. Imagine protected time. Imagine mentorship that wasn’t just a consultant saying, “Would you like to help with this audit I accidentally agreed to?” Imagine a system where research was meaningful, not mandatory. Sometimes I wonder what kind of science we could produce if we weren’t doing it half-delirious at 1 a.m. while simultaneously reheating leftover pasta and trying not to cry.

Until that fantasy world arrives, I’ll continue my nocturnal pilgrimage to the laptop, whispering the ancient trainee mantra: “Just get it done. Tick the box. Survive another year.” Because that is the unofficial curriculum of surgical research: Learn how to operate. Learn how to cope. Learn how to make terrible data look acceptable.
And if you’re very lucky — learn how to keep hold of the curiosity that made you care about any of this in the first place.

What about you? Have you been coerced into doing research that felt pointless, time-consuming, or unpublishable? How did it affect your training experience? Share your stories in the comments — I’d love to hear them.