- Email: [email protected]
Young doctors and the pressure of publication
Correspondence
Young doctors and the pressure of publication As young doctors from around the world who are engaged in research, we congratulate our Chinese colleagues (Feb 2, p e4)1 for their courage in highlighting the pressure to publish that trainees face. The “SCI article burden”, as HengFeng Yuan and colleagues call it, is omnipresent and weighs heavily on young doctors who aspire to become competent clinicians. Taking part in scholarly activity in residency is challenging, but there might be benefits that Yuan and colleagues do not address.2,3 Engaging in research is likely to develop analytical skills and promote critical thinking. It can drive the practice of evidence-based medicine and create an educational environment in which physicians are supported to do research.4 There is a clear rationale for requiring residents who are pursuing an academic career to publish; however, it should not be considered a global requirement for all trainees to collect peer-reviewed publications. There are fairer ways imaginable to encourage participation in research while relieving the pressure of publication on residents. In our era of competency-based education, it might be useful to look at ways to optimise individual pathways in residency and create additional learning opportunities.5 If a resident is able to show clinical competence early, why not allow him or her time and resources to focus on contributing to the evidence rather than just understanding it? For young doctors who want to publish, specific opportunities should be made available, but those who don’t should not be penalised—they could show scholarship in other areas. We declare that we have no conflicts of interest.
*Robbert Duvivier, Tim Crocker-Buqué, Matthew J Stull [email protected]
www.thelancet.com Vol 381 April 27, 2013
Global Health Workforce Alliance, 1211 Geneva, Switzerland (RD); Centre for Primary Care and Public Health, Queen Mary University of London, London, UK (TC-B); and Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA (MJS) 1
2
3
4
5
Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Rivera JA, Levine RB, Wright SM. Completing a scholarly project during residency training: perspectives of residents who have been successful. J Gen Intern Med 2005; 20: 366–69. Levine RB, Hebert RS, Wright SM. Resident research and scholarly activity in internal medicine residency training programs. J Gen Intern Med 2005; 20: 155–59. Rorthberg MB. Overcoming the obstacles to research during residency—what does it take? JAMA 2012; 308: 2191–92. Duvivier RJ, Stull MJ, Brockman JA. Shortening medical education. JAMA 2012; 308: 133–36.
Having experienced first-hand the pressure of acquired publication in China described by Heng-Feng Yuan and colleagues,1 we can attest to the challenges young doctors face in fulfilling the Science Citation Index (SCI) requirement. However, Yuan and colleagues fail to see the great benefit catalysed by an initiative to foster research in large and universityaffiliated hospitals. We believe that the mental framework instilled by engaging in the scientific process aids the transformation of young doctors into clinicians more capable of translating and adopting the massive amount of medical literature growing at an accelerating pace. Language is the real obstacle here. American medical education has blossomed under a similar model aimed at promoting research. A bilingual medical education would allow Chinese students to embrace the challenge of research and develop a more critical mind. We agree that SCI publications should not be tied to bonuses and promotions, but the spirit of global engagement is paramount. Peking Union Medical College Hospital (PUMCH), built by the Rockefeller Foundation, began as a complete transplantation of American medical education onto China. It promoted the advancement of modern medicine
by engaging in a fruitful exchange with the West that led some to call PUMCH “the Johns Hopkins of China”.2 It has since changed that policy, but in the age of the internet, lacking even the commonality of Google with readers of The Lancet says something about the cultural divide that Baidu users must slowly overcome. We declare that we have no conflicts of interest.
Nanze Yu, Kazi Zayn Hassan, Xiao Long, *Xiaojun Wang [email protected] Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China (NY, XL, XW); and Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (NY, KZH) 1
2
Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Brown Bullock M. An American transplant: the Rockefeller Foundation and the Peking Union Medical College. Berkeley: University of California Press, 1980.
Heng-Feng Yuan and colleagues1 describe the current pressure to publish placed on young Chinese doctors. This is their opinion rather than a fact. The Maoist revolution in China created legions of health-care workers called barefoot doctors. This idea provided health-care services for millions of people. Most Chinese physicians received limited training, although the government was working hard to raise the standard of medical education. In our experience, the pressure of publication exists mainly among candidates for the 8-year programme. Since most such candidates prefer a job in the tertiary hospitals in China, they naturally face tougher competition. Additionally, large hospitals have distinctive and complementary roles that reflect their various origins and missions and the ways they have responded to medicine’s complex and evolving needs. Consequently, a candidate is required to have proven clinical experience and advanced research to become a faculty member. Finally, medical advances often begin with basic scientific research.
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
e10
Young doctors and the pressure of publication As young doctors from around the world who are engaged in research, we congratulate our Chinese colleagues (Feb 2, p e4)1 for their courage in highlighting the pressure to publish that trainees face. The “SCI article burden”, as HengFeng Yuan and colleagues call it, is omnipresent and weighs heavily on young doctors who aspire to become competent clinicians. Taking part in scholarly activity in residency is challenging, but there might be benefits that Yuan and colleagues do not address.2,3 Engaging in research is likely to develop analytical skills and promote critical thinking. It can drive the practice of evidence-based medicine and create an educational environment in which physicians are supported to do research.4 There is a clear rationale for requiring residents who are pursuing an academic career to publish; however, it should not be considered a global requirement for all trainees to collect peer-reviewed publications. There are fairer ways imaginable to encourage participation in research while relieving the pressure of publication on residents. In our era of competency-based education, it might be useful to look at ways to optimise individual pathways in residency and create additional learning opportunities.5 If a resident is able to show clinical competence early, why not allow him or her time and resources to focus on contributing to the evidence rather than just understanding it? For young doctors who want to publish, specific opportunities should be made available, but those who don’t should not be penalised—they could show scholarship in other areas. We declare that we have no conflicts of interest.
*Robbert Duvivier, Tim Crocker-Buqué, Matthew J Stull [email protected]
www.thelancet.com Vol 381 April 27, 2013
Global Health Workforce Alliance, 1211 Geneva, Switzerland (RD); Centre for Primary Care and Public Health, Queen Mary University of London, London, UK (TC-B); and Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA (MJS) 1
2
3
4
5
Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Rivera JA, Levine RB, Wright SM. Completing a scholarly project during residency training: perspectives of residents who have been successful. J Gen Intern Med 2005; 20: 366–69. Levine RB, Hebert RS, Wright SM. Resident research and scholarly activity in internal medicine residency training programs. J Gen Intern Med 2005; 20: 155–59. Rorthberg MB. Overcoming the obstacles to research during residency—what does it take? JAMA 2012; 308: 2191–92. Duvivier RJ, Stull MJ, Brockman JA. Shortening medical education. JAMA 2012; 308: 133–36.
Having experienced first-hand the pressure of acquired publication in China described by Heng-Feng Yuan and colleagues,1 we can attest to the challenges young doctors face in fulfilling the Science Citation Index (SCI) requirement. However, Yuan and colleagues fail to see the great benefit catalysed by an initiative to foster research in large and universityaffiliated hospitals. We believe that the mental framework instilled by engaging in the scientific process aids the transformation of young doctors into clinicians more capable of translating and adopting the massive amount of medical literature growing at an accelerating pace. Language is the real obstacle here. American medical education has blossomed under a similar model aimed at promoting research. A bilingual medical education would allow Chinese students to embrace the challenge of research and develop a more critical mind. We agree that SCI publications should not be tied to bonuses and promotions, but the spirit of global engagement is paramount. Peking Union Medical College Hospital (PUMCH), built by the Rockefeller Foundation, began as a complete transplantation of American medical education onto China. It promoted the advancement of modern medicine
by engaging in a fruitful exchange with the West that led some to call PUMCH “the Johns Hopkins of China”.2 It has since changed that policy, but in the age of the internet, lacking even the commonality of Google with readers of The Lancet says something about the cultural divide that Baidu users must slowly overcome. We declare that we have no conflicts of interest.
Nanze Yu, Kazi Zayn Hassan, Xiao Long, *Xiaojun Wang [email protected] Division of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China (NY, XL, XW); and Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (NY, KZH) 1
2
Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Brown Bullock M. An American transplant: the Rockefeller Foundation and the Peking Union Medical College. Berkeley: University of California Press, 1980.
Heng-Feng Yuan and colleagues1 describe the current pressure to publish placed on young Chinese doctors. This is their opinion rather than a fact. The Maoist revolution in China created legions of health-care workers called barefoot doctors. This idea provided health-care services for millions of people. Most Chinese physicians received limited training, although the government was working hard to raise the standard of medical education. In our experience, the pressure of publication exists mainly among candidates for the 8-year programme. Since most such candidates prefer a job in the tertiary hospitals in China, they naturally face tougher competition. Additionally, large hospitals have distinctive and complementary roles that reflect their various origins and missions and the ways they have responded to medicine’s complex and evolving needs. Consequently, a candidate is required to have proven clinical experience and advanced research to become a faculty member. Finally, medical advances often begin with basic scientific research.
Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/
e10