Wednesday, October 19, 2011

Publish or Perish? But Where?

One of the drivers of the proliferation of journals, both online and print, is the requirement of most Residency Review Committees that faculty of residency training programs must engage in research. This rule is not “evidenced-based,” as there is no proof that a surgeon has to do research in order to be a good teacher or role model. Sometimes the opposite is true; the researcher can’t teach at all.

Residents choose to train at community hospitals because they do not want to participate in research. [Anecdotally, I think many residents at university hospitals would rather not do research too.] As is the case with faculty, there is no proof that forcing a resident to do research will result in important discoveries or make her a better surgeon.

Look at this language from the RRC forSurgery.

Some members of the faculty should also demonstrate scholarship by one or more of the following:

II.B.5.b).(1) peer-reviewed funding;
II.B.5.b).(2) publication of original research or review articles in peer-reviewed journals, or chapters in textbooks;
II.B.5.b).(3) publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings

Since I dropped out of the business of training residents, I have been actively blogging and not cranking out mindless publishable research. Here is an interesting fact. I have no doubt that far more people have read what I have written in my blog for a year and a half than ever read all of my 95 published works combined.

For example, I wrote a blog entitled “Statistical vs. Clinical Significance: They Are Not the Same” in August of 2011. To date, it has been viewed 4466 times. I would guess that one post alone has been read by more people than ever have read my combined published papers. I have 1070 followers on Twitter. Again, it is likely that more people have read what I tweet than ever read my scholarly works.

So what’s the point? Although I have written that individuals who participate actively in social media like Twitter have very little influence when one looks at the big picture, the same can be said of publishing a journal article. Who really reads the 25 or so critical care journals that are currently being published online and in print? [See my blog about this.]

Did I have more influence with my published writings or do I have more influence now with my blogging and tweeting? What do you think?

PS: Just like a journal article, I have cited myself three times.


Gwynedd said...

My program is currently considering a proposal (from our Research Director) that ALL residents in our program who do not already have a PhD upon entering be required to undertake at least 2 years of research (i.e., acquire at least a Master's, ideally a PhD) during their residency. Neurosurgery residency is still 6 years in Canada but given the changes in training requirements that's set to go up to 7 as it did in the US. Add in a PhD, it's an automatic 10+ years...

Current residents would be exempt, but one of them recently came to talk to me about the whole issue of research. She's going to be a good, solid clinician, the type you want as a colleague, who gets the work done, and she's not interested in running a lab, but she's getting the message on numerous fronts that you need research qualifications/CV publications to be considered for any kind of decent job. She's wondering if she should spend two or three years pursuing a degree which in the end she's not going to put to good use, just to be competitive.

Perhaps I should tell her to get a Twitter account...

Skeptical Scalpel said...

Great comment. Thanks. This is really a shame. 10 years. And will it make her a better surgeon? I doubt it. She might waste the equivalent of 3 years on Twitter, but it wouldn't be as obvious.

Nofame4u said...

When I left MedSchool in Germany after having experienced lots of teachers without motivation for teaching but promoting their university career with doubtful research and unread papers instead, I had a first interview for a job in the universities Neuro department. I offered engagement in teaching, what I prefer much to basic research, but guess what, they showed no interest at all. It's a shame that teaching is so unvalued compared to research, in non-UK Europe unfortunately even more than elsewhere...

Skeptical Scalpel said...


I assure you that what you describe is not unique to Europe. The same is true here in the US.

Murfomurf said...

And Australia/NZ.
I see relatively young "specialists" heading clinical departments- have done no more than minimum clinical, but have always been glued to their computers writing up research and being clever doing their own statistics and mathematical modeling. It puts off both the steady clinicians and the good teachers! It even alienates non-clinical researchers who used to make a living helping clinicians do research studies, analysing them and writing them up!

Skeptical Scalpel said...


Well said and again, not just where you are.

Anonymous said...

You may be interested in this article "WHY ARE MEDICAL JOURNALS SO DULL?" published wayback in 1958, I also believe that Richard Asher had more to say on the subject in his seven sins of medicine.

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