Assessing the Magnitude of a Surgical Career Through His Trainees: The John L. Cameron Legacy Factor

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The accomplishments of an individual surgeon and department chair may be quantified in myriad ways. Impact can be measured by the number of operations performed, by scientific discoveries, by the leadership positions held, the environment created by the faculty hired, by the institution and its resources, and notably by those who have been trained and influenced by this surgeon. As the operative career of John L. Cameron comes to a close this perspective focuses on a single sphere of his storied career: his influence on the training of academic surgeons during his time as the William Stewart Halsted Chair and Chief of Surgery at the Johns Hopkins Hospital in Baltimore, Maryland from the years 1984 to 2003. Dr Cameron's long-lasting and trans-generational impact on the fields of general and hepatopancreaticobiliary surgery has been described in both the academic and lay presses;1 indeed, former trainees have gone on to hold some of the highest positions within medical institutions and societies, across the range of subspecialties.
As is well known, Dr William Stewart Halsted was the first chief of surgery at the Johns Hopkins Hospital. While his innovative and influential accomplishments are well documented in medical science, perhaps his two most important accomplishments were the introduction of the philosophy of safe surgery and the initial system for training surgical residents.2,3 Halsted's biographers took care to enumerate his scientific and technological contributions, but they also suggested that his broader impact was evidenced by the fact that those “who went out from his operating room were magnificently trained, and are among the great ornaments of American surgery.” 2,3 We believe John Cameron has had a similar impact through the 106 individuals he has directly trained. This impact extends to those trained, in turn, by his trainees who have held positions as chairs or program directors. Borrowing from a theory of “collaborative distance” between investigators, that is, the degree to which they are related as coauthors, we propose the term “the Cameron Legacy Factor” as one metric of his influence. A measure of collaborative distance is useful for two reasons: (1) it describes the sheer number of individuals who were influenced directly by the individual, and (2) it also describes the depth and breadth of influence across fields and generations. The most famous of these include the Erdös number, which is named for the highly prolific mathematician Paul Erdös.4 Mathematicians who coauthored a manuscript with Paul Erdös are said to have an Erdös number of 1, those who authored papers with the coauthors, are said to have an Erdös number of 2, and so forth. Thus, the 106 individuals who trained under the chairmanship of John L. Cameron are said to have a Cameron Factor of 1. Individuals who completed residency or fellowship training under a chair, institute director, or program director with a Cameron Factor of 1 are considered to have a Cameron Factor of 2.
Of these 106 trainees, 84.0% (n = 89) pursued academic careers and 25.5% (n = 27) pursued careers in a private hospital or practice. Seventeen percent (n = 18) had careers that spanned both sectors simultaneously. Of those who pursued academic tracks as of 2015, 52.8% (n = 47) achieved the rank of full professor, 71.9% (n = 64) achieved the rank of associate professor, and 20.2% (n = 18) achieved the rank of institute director or chair. Of the individuals whose careers included a private institution, 37% (n = 10) were appointed chiefs of divisions, and 55.6% (n = 15) were appointed to positions that included departmental chairs or leadership boards.
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