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Do Medical Student Publications in Hand Surgery Follow the Money?
Samantha Maasarani, M.D., M.P.H., Cleveland Clinic, Cleveland, OH, Katelyn C. Donnelly, M.P.H., University of Buffalo, Buffalo, NY and Shelley S. Noland, MD, Department of Orthopaedics and Sports Medicine, Mayo Clinic, Phoenix, AZ

INTRODUCTION
The National Institution of Health (NIH) is the largest public funder of biomedical research in the world.1 The present study analyzes the relationship between an institution's NIH funding and their medical student publications in the hand surgery literature.

METHODS
A retrospective review of all publications from in
Journal of Hand Surgery (American volume) from January 2016-February 2021 was completed. Descriptive data was collected for each publication's year, study design, topic, and institutional affiliation. Each institution's financial award summary for fiscal year 2020 was identified by querying the NIH Research Portfolio Online Reporting Tools.2 The institutions were then split into three cohorts based on their amount of NIH funding: upper-tier institutions received $500,000,000 to $800,000,000 of funding; middle-tier institutions received $499,999,999 to $100,000,000 of funding; and lower-tier institutions received less than $99,999,999 of funding. Publications from non- academic centers or with international affiliations were excluded from our study. The primary outcome was to assess the publication rates of each cohort. The secondary outcome was first author medical student publications, defined as the first author not having a medical degree (M.D. or D.O.). This was further confirmed by the author having a B.A., B.S., M.P.H., or M.S. degree after their name alongside an institutional affiliation. Any first author with M.D., D.O., PA-C., or international M.D. equivalents were excluded from the primary outcome.
RESULTS
A total of 1,293 publications were initially analyzed. Following exclusion of publications with international (n=415) or non-academic (n=62) affiliations, 816 total publications were included. Overall, these publications were most commonly from Harvard University (n=63, 7.72%), Mayo Clinic Minnesota (n=55, 6.74%), and Stanford University (n=55, 6.74%). The middle-tier cohort published the most (n=376, 46.08%), the upper-tier had 234 publications (28.68%), and the lower-tier cohort published the least (n=206, 25.25%). 90 publications contained a medical student as their first author. The most common topics were medical/resident education related (n=20, 10.58%), trauma (n=14, 7.41%), and distal radius fracture (n=14, 7.41%). Publications from the higher-tier cohort had significantly increased odds of the first author being a medical student (OR 1.86, 95% CI 1.13- 3.05) compared to the middle-tier cohort. A positive correlation exits between an institution's NIH funding and medical students' research involvement (Pearson
R = 0.11, p=0.0018).
CONCLUSION
•An institution's amount of NIH funding positively correlates with medical students' research involvement.
•These results provide medical students with valuable information that highlight institutions inclusive of medical student scholarly activity in hand surgery.



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