[Surgical research in the Netherlands. The Dutch experience with clinical studies in surgery].

A large number of good surgical studies have been published in The Netherlands, putting the country at the top of the list in the Western world. It is remarkable that the highest productivity was found in small countries and in countries with a low population. Most of the large European countries have a low scientific output according to the method used in the present study. The Scandinavian countries, Holland, and Switzerland have the best scientific index according to these results. It could be that the larger countries, such as Germany, Italy, France, and Spain, tend more to publish in national journals. Perhaps it is not common in some some countries and regions to publish data in English--which certainly has a negative effect on the scientific index of such a country. The high productivity found among Dutch surgeons could be explained by the fact that the 700 surgeons in a small country with a relatively high population are well organized: Almost all Dutch surgeons are members of the national surgical society. All of them can speak and write English very well. Participation in the activities organized by the national society is high. Scientific meetings where surgeons and assistants get together for a day or two are held twice a year. In addition quality controls are carried out at all teaching and nonteaching hospitals. Through this the surgeons in this relatively small country know each other quite well, which promotes cooperation when studies are undertaken. The Netherlands is just large enough for relevant clinical studies to be conducted and it may be that we initiate a relatively large number of such studies. It is a democratic country in which surgeons and researchers are offered the freedom and opportunity to conduct research and publish their results as they like without being hindered by hierarchic structures. Together, these factors create a scientific climate in The Netherlands which stimulates the organization of multicenter and clinical studies.