From One Thesis to a Multi-Manuscript Portfolio: An Educational Research Model for Surgical Residents in Resource-Constrained Public Hospitals

Background: High-impact research among surgical residents in public hospitals is rare in low- and middle-income countries (LMICs) due to structural barriers like limited research time, poor data infrastructure, minimal mentorship, and lack of funding. Traditional single-thesis models seldom yield international publications. This study presents a replicable multi-manuscript portfolio approach, offering an innovative shift from traditional frameworks by fostering greater scholarly output and potentially improving clinical research standards in resource-limited settings. Objective: To outline the design, ethical approval, methods validation, and editorial results of a 9-manuscript research portfolio from one institutional registry, highlighting its practical use for residents in resource-limited programs. Methods: We created nine connected manuscripts from a vascular surgery registry (n=176 peripheral artery disease (PAD) patients, 2018–2024) at a public hospital in Mexico City. The methodology manuscript (M3) demonstrated high inter-rater reliability (κ=0.97). Each manuscript addressed separate clinical questions for distinct audiences, with unified ethical clearance (RPI-ISSSTE-2025-0033). Results: From January 2024 to January 2026, outcomes included three preprints with DOIs, international editorial interest, verified manuscript independence, and faster review when methodology was validated first. The total process spanned 24 months. Conclusions: A rigorously validated multi-manuscript portfolio is achievable during residency in resource-limited settings and can be replicated by any resident with access to a registry, an external validator, and early documentation. Institutions can adopt this model by establishing centralized registries, facilitating external validation partnerships, and encouraging early methodological planning among residents.