Historic
William Withering discovered digitalis around 1779, Edward Jenner discovered the smallpox vaccine around 1798, Claude Bernard clarified the human physiology of circulation, Louis Pasteur found that micro-organisms cause fermentation, Robert Koch elucidated medical microbiology, and Albert Einstein proposed the theory of relativity. In the 17th century, William Harvey discovered circulation, and Thomas Sydenham was renowned for his studies on malarial fevers, dysentery, scarlet fever, measles, and cholera. Their era marks the change in medicine from clinical observation to contemporary experimental medicine.

How did they arrive at their discoveries?
Their discoveries occurred either by forethought or by serendipity; they were never isolated. Research and discovery is the pursuit to answer a question combined with various combinations of luck and lateral thinking in a prepared mind. Louis Pasteur said, “Chance favors only the prepared mind,” and Kettering added, “Keep going and the chances are that you will stumble on something perhaps when you are least expecting it. I have never heard of anyone stumbling on something sitting down.” Salvarsan was the 606th compound tested by Paul Ehrlich against syphilis. The discovery of tumorigenic herpes virus by Epstein and Barr occurred after many failures.

The definition of research 
Sir Kenneth Dover, in his writings on the Greeks of 2000 years ago, said, “Their readiness to ask ‘why?’ and ‘why not?’ combined with a conviction that only some reasoned and clearly expounded answers to those questions were worth listening to.” Research is faith in a rational world, governed by cause and effect for everything.

Motivations for medical research
Motivations are either altruistic (to disseminate knowledge and research selectivity), or they are egoistic (to respond to the publish-or-perish pressure when climbing the ladder to a successful career or to an academic or professional promotion, to become famous, to develop professional contacts, or for financial gain).

Benefits of research for trainee doctors 
In 1966, Adler said that the faculties developed by performing research are those needed for making diagnoses. The benefits of performing research include developing a critical and scientific attitude toward old approaches to treatment and investigation, studying the scientific method and properly using statistics to evaluate treatments and investigations, studying a research topic in depth via a literature search, learning to use a library, learning to assess the medical literature critically, understanding others’ routine laboratory methodologies, and obtaining a higher degree.

Prerequisite for successful medical research
Before answering the why? of research, the researcher must have the following: useful personal qualities (eg, curiosity, enthusiasm, and talent), an original idea to be tested, the means to test the idea, access to a specialist’s library, and someone to talk to about the research (ie, a mentor).

The research idea
The research idea must be original. It could be an observation; it could come from talks, lectures, discussions, reading, and writing about a specific subject; or it could be personal inquisitiveness and dreaming.

Karl Popper said, “What a good teacher says is this: ‘Try to learn what people are discussing nowadays in science. Find out where difficulties arise and take interest in disagreement.’ These are the questions you should take up.”

Categories of research ideas in medicine include a question in current practice, looking for a problem and proposing a solution, and providing new concepts.

Tests for a research idea 
The preliminary tests of a potential research idea include the following: The writing test (If you cannot write it down, then it is unrealistic). The credibility test (Does it make sense? Does it fit in with current knowledge about the topic?). The friendly colleague test (Does he understand it? [Be aware of “It can’t be done”]). The freshness test (Can it be answered through a literature search?). The possibility test (Is it feasible? Is it falsifiable? Is there sufficient basic knowledge? Can it be validated statistically? Can a pilot study be successfully conducted?). The definitive test for a potential research idea is to test the hypothesis with the scientific method. The hypothesis is put to the test by experiment and if it survives intact, we can assume we have discovered the true explanation for our idea/observation: this is new knowledge with supporting evidence and not empirical knowledge.

Project planning 
Project planning is developing an idea into a proposition that you can produce a useful product within a specific time. This includes writing up the project protocol.

The checklist in project planning includes the following: 

• Define the project (through thinking about it and discussing it).
• Examine the resources (ie, financial, human, equipment, facilities) in terms of desirability and affordability.
• Determine a start date (considering the time needed to collect resources and perform the project).
• Testing methods (accepted vs untried).
• Will there be any profit or publication at the end?
• Can the research progress be measured against time?
• How will the data be analyzed?

Research project protocol 
The definition of a research project protocol is the basic structure of the research project and a formal document of the plan for the research project. It states the idea and the means for testing it, the time and the money that will be required, and what is to be expected.

Its structure includes:

1. Introduction: Describes the need for the research as supported by the literature (references required).
2. Aim: Follows from the introduction. Define what the study seeks to determine.
3. Statement of the problem as you see it: The introduction is expanded as a question with a probable answer.
4. Methods: Describes the exact procedure, the population to be studied, the laboratory methods and equipment to be used (the sample size should be justified).
5. Analysis and interpretation: Describes how you intend to analyze the data. The evaluation of the results, assumptions, and justifications you intend to use must be written here.
6. Proposed schedule: Detailed timetable of the work from start to finish. 
7. Facilities: Describe available versus expected. 
8. Finance: Present a budget of expected costs for each year of the research project including staff, equipment, and consumables. 
9. Appendices: Criteria for inclusion, sample size, questionnaires, methods of coding or identification.

Some persons choose to train in research-oriented hospital centers without realizing that they will be faced with performing research. Research is fine if you like it, but it requires a year or 2 of training in the laboratory. Some information acquired will be significant and important to surgical progress and some of it will be nonsignificant data. However, to keep yourself at the forefront of the academic ranks, the publish-or-perish philosophy is just as important in academic surgery as it is in other fields of academic endeavor.

Further readings

1. Popper K. Conjectures and Refutations: The Growth of Scientific Knowledge. 5th ed. Oxford, United Kingdom: Routledge; 2002. 
2. Calnan J. Coping with Research: The Complete Guide for Beginners. London, United Kingdom: William Heinemann Medical Books; 1985.
3. Hawkins C, Sorgi M, eds. Research. How to Plan, Speak and Write About it. Berlin and Heidelberg: Springer-Verlag; 1985.
4. Deen KI, Kumar RR, eds. Successful Surgical Research. Kent, United Kingdom: Anshan; 2006.