- Email: [email protected]
WHO IS AN AUTHOR?
1042 used to be the BTA (been to America), now it is the thesis. Even ifwe have two different types of thesis, as Calnel suggests, some candidates will acquire both in the hope of being ahead of their rivals. Surgical training should have four broad phases:
inequality between nations. Give the people responsibility for their development, and they will overcome whatever tyranny is to
oppressing them, be it hunger, disease, or government. It freedom of all people that is our ultimate goal. Milo
is the
Hospital,
senior /tOMM-o//:cff.
PO Box 32, Njombe, Tanzania
P. D. EUNSON .
senior
only wholeheartedly agree with Mr Irwin and Roy (Oct 13, p 859) about the ludicrous stampede to publish as much as possible in the shortest possible time to beat the competition in the climb to seniority in surgery. The "publish or perish" mentality has come about because of an outdated, hierarchic career structure in which there is unreasonably fierce competition and no long-term security at junior level. The only direction for a surgical trainee is up, but the catch is the senior registrar bottleneck. I am one of the unfortunate many who has attained two surgical fellowships, spent a year abroad doing research, and is frenetically trying to complete the "essential" mastership thesis. The paperchase will continue until something is done about the career structure. The suggestion by Irwin and Roy that interview panels should place less emphasis on the number of publications a candidate has accumulated is welcome, but unless trainees are given a reasonable chance of reaching the top of their profession with some form of security it will never happen. I suggest residency programmes, similar to those seen in North America, which could easily include some time spent on research but without the absolute need to produce a thesis. A proper incremental salary scale to include periods of research, as suggested by Egdell,l would can
Professor
mean
there would be
no
and be
critical;
PUBLISH OR BE DAMNED
SIR,-I
—learning to manage surgical patients; registrar. -learning to operate; research post (clinical or laboratory).-learning to think, analyse,
need for the considerable financial strains
imposed by academic work. The lowered salary together with the costs of typing, copying, and binding, not to mention the thesis entrance fee, illustrate how unfair it is to impose on surgical trainees the production of a lengthy dissertation just because "everyone else is doing it". Burnand and Young2suggest that the price may be too . high, and this refers not only to hard cash but also to the 3loss of time for leisure and to relax and to the impact on family life.3 The career structure should be replaced with well thought out, planned training programmes. A finite number of places should be available, giving a high standard of training so that the individual, at the end of the programme, can serve his patients competently and be able to earn a secure living. Only then will the mounds of irrelevant publications by desperate juniors decrease. King’s Mill Hospital, Sutton-in-Ashfield, Notts NG17 4JL
B. A. PRICE
registrar. -remedying deficiencies in clinical experience, increasing and developing a special interest.
independence,
If we can agree on that plan, different types of research will be appropriate to different future careers. Ideally most research should be in a subject that will be a lifetime interest, not some obscure topic
clinical surgery. One of the troubles is that many a professorial unit necessarily involves rows of rats or parades of Pavlov pouches!
unrelated
to
surgeons still think that research in University Surgical Unit, Royal Hallamshire Hospital, Sheffield S10 2JF
1. Calne RY. Surgical research: curiosity and luck: Ann Roy Coll Surg Engl 1984; 66: 211-13.
A. G. JOHNSON personal observations and
prejudices
WHO IS AN AUTHOR?
SIR,-The thorny question of multiauthorship of papers (Oct 6, p 815) might well be resolved by convening an international in the same way that reference style is determined by the Vancouver convention. It seems unrealistic and also pointless for more than six individuals to claim to be principal authors, since Vancouver style citation in reference lists would refer by name only to the first three with the rest consigned to "et al". The Index Medicus names the first author only, which underlines the care which should go into selecting the batting order. However, there are many occasions, especially in multicentre studies, when large numbers of investigators have made a contribution, but could not possibly all have had a chance to determine the contents of the final publication. A way round this difficulty is the format "Brown AB, Green MN, White YZ, and the Homoeopathy Research Group", with the names of all of the other major participants as a footnote. Authorship of articles may reflect academic distinction, but it carries real weight only if the author is first in the named list of principals or one of only two or three authors. The only exception to this rule is perhaps the author who claims the glory of being the director of the research institute which provided the rats and the cash, when the name should be last in the list. The suggestion of limiting principal authors to six would contain some of the problems currently experienced. I have no personal axe to grind, having lately been a solitary Lancet author (Sept 15, p 621) and also one of fifty-four (Sept 22, p 659).
symposium,
’
1.
Egdell D. The career structure: an indication for major surgery? Br Med J 1984; 289: 709-10.
2. Burnand
KG, Young AE. What price the mastership in surgery? Lancet 1984; i:
1114-15. 3. Leaman A. The
family must come
first. World Med 1984; 19
(22):
8.
Department of Medicine, Bishop Auckland General Hospital, Bishop Auckland, Co Durham DL14 6AD
SOUTH AFRICA’S CHILDREN
SlR,—Mr Irwin and Professor Roy rightly point out that selection committees in surgery may take too much notice of the length of a candidate’s publication list, to the exclusion of clinical skills. Nowadays most committee members are not so inexperienced as to be deceived by quantity rather than quality and often ask about the publications at interview or look up the papers beforehand. Every committee I have been on, over the past 5 years, has put considerable emphasis on clinical experience and the posts have by no means always gone to the candidate with the most publications or a completed thesis. Having said that, a completed thesis and goodquality publications do show that a candidate is familiar with a certain area and has made a contribution to it. The reason some ofus like to see a completed thesis is that, all too often, we have been assured that the research "is being written up" only to find that once the candidate is appointed, no thesis or papers ever appear. Although it is difficult to complete work after moving away from the research unit, this is a serious waste of time and money. As long as there is such intense competition for senior registrar posts, candidates will try to do "something extra" to gain advantage. It
M. C. BATESON
SIR,-Independent national states in South Africa do indeed provide their own health services, but it is misleading of Dr Domisse (Aug 4, p 290) to suggest that the services mentioned in my letter of June 30 (p 1472) are unavailable to the inhabitants of those national Estimates for these states indicate that 4. 1% ofa total gross national product of about R 6371 million! is spent on health, which is higher the 2-307o average allocation in Third World countries2 and only slightly less than the 4 . 6°70 (1980) spent on health by the Republic of South Africa. Expenditure on health is defrayed from taxes collected by these states. It is equally untrue that my comments on primary health care (breast-feeding, oral rehydration fluids, and so on) refer only to "a restricted and morbidity-limited part of South Africa". The truth (a truth I admit with some reluctance) is that in primary health care some of the national states outperform certain areas under the jurisdiction of my own department. The tuberculosis statistics are also at variance with what Domisse states: whether the national states are included or excluded, the states.
than
inequality between nations. Give the people responsibility for their development, and they will overcome whatever tyranny is to
oppressing them, be it hunger, disease, or government. It freedom of all people that is our ultimate goal. Milo
is the
Hospital,
senior /tOMM-o//:cff.
PO Box 32, Njombe, Tanzania
P. D. EUNSON .
senior
only wholeheartedly agree with Mr Irwin and Roy (Oct 13, p 859) about the ludicrous stampede to publish as much as possible in the shortest possible time to beat the competition in the climb to seniority in surgery. The "publish or perish" mentality has come about because of an outdated, hierarchic career structure in which there is unreasonably fierce competition and no long-term security at junior level. The only direction for a surgical trainee is up, but the catch is the senior registrar bottleneck. I am one of the unfortunate many who has attained two surgical fellowships, spent a year abroad doing research, and is frenetically trying to complete the "essential" mastership thesis. The paperchase will continue until something is done about the career structure. The suggestion by Irwin and Roy that interview panels should place less emphasis on the number of publications a candidate has accumulated is welcome, but unless trainees are given a reasonable chance of reaching the top of their profession with some form of security it will never happen. I suggest residency programmes, similar to those seen in North America, which could easily include some time spent on research but without the absolute need to produce a thesis. A proper incremental salary scale to include periods of research, as suggested by Egdell,l would can
Professor
mean
there would be
no
and be
critical;
PUBLISH OR BE DAMNED
SIR,-I
—learning to manage surgical patients; registrar. -learning to operate; research post (clinical or laboratory).-learning to think, analyse,
need for the considerable financial strains
imposed by academic work. The lowered salary together with the costs of typing, copying, and binding, not to mention the thesis entrance fee, illustrate how unfair it is to impose on surgical trainees the production of a lengthy dissertation just because "everyone else is doing it". Burnand and Young2suggest that the price may be too . high, and this refers not only to hard cash but also to the 3loss of time for leisure and to relax and to the impact on family life.3 The career structure should be replaced with well thought out, planned training programmes. A finite number of places should be available, giving a high standard of training so that the individual, at the end of the programme, can serve his patients competently and be able to earn a secure living. Only then will the mounds of irrelevant publications by desperate juniors decrease. King’s Mill Hospital, Sutton-in-Ashfield, Notts NG17 4JL
B. A. PRICE
registrar. -remedying deficiencies in clinical experience, increasing and developing a special interest.
independence,
If we can agree on that plan, different types of research will be appropriate to different future careers. Ideally most research should be in a subject that will be a lifetime interest, not some obscure topic
clinical surgery. One of the troubles is that many a professorial unit necessarily involves rows of rats or parades of Pavlov pouches!
unrelated
to
surgeons still think that research in University Surgical Unit, Royal Hallamshire Hospital, Sheffield S10 2JF
1. Calne RY. Surgical research: curiosity and luck: Ann Roy Coll Surg Engl 1984; 66: 211-13.
A. G. JOHNSON personal observations and
prejudices
WHO IS AN AUTHOR?
SIR,-The thorny question of multiauthorship of papers (Oct 6, p 815) might well be resolved by convening an international in the same way that reference style is determined by the Vancouver convention. It seems unrealistic and also pointless for more than six individuals to claim to be principal authors, since Vancouver style citation in reference lists would refer by name only to the first three with the rest consigned to "et al". The Index Medicus names the first author only, which underlines the care which should go into selecting the batting order. However, there are many occasions, especially in multicentre studies, when large numbers of investigators have made a contribution, but could not possibly all have had a chance to determine the contents of the final publication. A way round this difficulty is the format "Brown AB, Green MN, White YZ, and the Homoeopathy Research Group", with the names of all of the other major participants as a footnote. Authorship of articles may reflect academic distinction, but it carries real weight only if the author is first in the named list of principals or one of only two or three authors. The only exception to this rule is perhaps the author who claims the glory of being the director of the research institute which provided the rats and the cash, when the name should be last in the list. The suggestion of limiting principal authors to six would contain some of the problems currently experienced. I have no personal axe to grind, having lately been a solitary Lancet author (Sept 15, p 621) and also one of fifty-four (Sept 22, p 659).
symposium,
’
1.
Egdell D. The career structure: an indication for major surgery? Br Med J 1984; 289: 709-10.
2. Burnand
KG, Young AE. What price the mastership in surgery? Lancet 1984; i:
1114-15. 3. Leaman A. The
family must come
first. World Med 1984; 19
(22):
8.
Department of Medicine, Bishop Auckland General Hospital, Bishop Auckland, Co Durham DL14 6AD
SOUTH AFRICA’S CHILDREN
SlR,—Mr Irwin and Professor Roy rightly point out that selection committees in surgery may take too much notice of the length of a candidate’s publication list, to the exclusion of clinical skills. Nowadays most committee members are not so inexperienced as to be deceived by quantity rather than quality and often ask about the publications at interview or look up the papers beforehand. Every committee I have been on, over the past 5 years, has put considerable emphasis on clinical experience and the posts have by no means always gone to the candidate with the most publications or a completed thesis. Having said that, a completed thesis and goodquality publications do show that a candidate is familiar with a certain area and has made a contribution to it. The reason some ofus like to see a completed thesis is that, all too often, we have been assured that the research "is being written up" only to find that once the candidate is appointed, no thesis or papers ever appear. Although it is difficult to complete work after moving away from the research unit, this is a serious waste of time and money. As long as there is such intense competition for senior registrar posts, candidates will try to do "something extra" to gain advantage. It
M. C. BATESON
SIR,-Independent national states in South Africa do indeed provide their own health services, but it is misleading of Dr Domisse (Aug 4, p 290) to suggest that the services mentioned in my letter of June 30 (p 1472) are unavailable to the inhabitants of those national Estimates for these states indicate that 4. 1% ofa total gross national product of about R 6371 million! is spent on health, which is higher the 2-307o average allocation in Third World countries2 and only slightly less than the 4 . 6°70 (1980) spent on health by the Republic of South Africa. Expenditure on health is defrayed from taxes collected by these states. It is equally untrue that my comments on primary health care (breast-feeding, oral rehydration fluids, and so on) refer only to "a restricted and morbidity-limited part of South Africa". The truth (a truth I admit with some reluctance) is that in primary health care some of the national states outperform certain areas under the jurisdiction of my own department. The tuberculosis statistics are also at variance with what Domisse states: whether the national states are included or excluded, the states.
than