- Email: [email protected]
What American surgeons read: a survey of a thousand Fellows of the American College of Surgeons
ORIGINAL REPORT
What American Surgeons Read: A Survey of a Thousand Fellows of the American College of Surgeons Moshe Schein, MD, Ramesh Paladugu, MD, Vesna G. Sutija, PhD, and Leslie Wise, MD Department of Surgery, New York Methodist Hospital and Cornell University Medical College, Brooklyn, New York PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are “popular,” and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the “popularity” of journals with their IFs. METHODS: A questionnaire was mailed to 1000 American
surgeons, randomly selected from a list provided by the American College of Surgeons. RESULTS: A total of 418 surgeons responded, and 371 re-
sponses could be analyzed (37%). The leading sources of medical information were medical literature (93%), professional meetings (88%), and CME courses (69%). The average time per surgeon/month dedicated to medical literature was 14 hours (range, 1 to 120). Peer-reviewed journals were read by 95%, textbooks by 68%, and update series by 60% of the respondents. The three most popular surgical journals were Annals of Surgery (IF, 5.40), selected by 60%; Journal of the American College of Surgery (IF, 1.87), selected by 48%; and Archives of Surgery (IF, 2.53), selected by 36%. The most popular subspecialty journals were Cancer (IF, 3.66), selected by 31%; Critical Care Medicine (IF, 3.74), selected by 17%; and Gastroenterology (IF, 10.33), selected by 12%. The New England Journal of Medicine (IF, 28.66), selected by 67%, and the Journal of the American Medical Association (IF, 9.55), selected by 66%, were the most popular general medical journals, followed by Mayo Clinic Proceedings (IF, 1.98), selected by 16%. Among the “leaders” on the IF list for international, British medical and surgical journals were Lancet (IF, 11.79), selected by 5%, and
Correspondence: Inquiries to Moshe Schein, MD, Department of Surgery, New York Methodist Hospital, 506 Sixth St, Brooklyn, NY 11215; fax: (718) 780 3154; e-mail: [email protected]
252
British Journal of Surgery (IF, 2.38), selected by 0.5% of the respondents. CONCLUSIONS: Those American surgeons responding con-
sider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non– United States publications and select the journals they read without considering its IF. (Curr Surg 2000;57:252–258. © 2000 by the Association of Program Directors in Surgery.) KEY WORDS: CME, surgical education, surgical literature,
impact factor, surgical journals
INTRODUCTION Modern American surgeons, together with their colleagues in other specialties, are immersed in an ever-deepening sea of printed and electronic information.1 Over 4000 medical journals, in 40 languages, are currently published around the world. Fifty-two percent of these journals are published in the United States. Eighty eight percent of all published articles are in English. MEDLINE files contain over 9.2-million bibliographic citations and abstract records; a total of 31,000 new citations are added each month. The National Library of Medicine lists a total of 669 surgical journals,201 of which are “indexed” and cited by Index Medicus and its counterparts. A search using the key word “surgery” through the Internet bookshop websites, such as Amazon.com or barnesandnoble.com, disclosed 7658 and 5170 books, respectively (on March 27, 1999). Over 5000 professional medical links are available on the Internet. Add to this material national and international conferences, courses, and institutional CME events. Who has the time to read? Although publishers know how many journals and books they publish and sell, and journals can quote their calculated impact factor (IF), citation half-life, and other parameters, no information exists whatsoever about what surgeons read and how much. It is also unclear whether surgeons prefer journals ranking highly on the IF list. To explore which information
CURRENT SURGERY • © 2000 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/00/$20.00 PII S0149-7944(00)00177-X
sources surgeons currently rely on, and which journals they prefer, we initiated this study.
METHODS A questionnaire was mailed to 1000 American surgeons, randomly selected from a list provided by the American College of Surgeons. The entire questionnaire is reproduced in Appendix 1. “Popularity” of a journal was measured as the percent of times it was mentioned as a first, second, or third choice. A database was generated from valid survey responses. The statistical analyses were performed by SPSS software (SPSS Inc., Chicago). The relationship between continuous variables was assessed with t tests and the analysis of variance (ANOVA). The relationships among categorical variables were evaluated by 2 (chi-square). A Spearman correlation coefficient was used with ranked variables. All comparisons included any cases with valid data. An ␣ ⫽ 0.05 was considered statistically significant. The IF of the various journals was retrieved from the Science Citation Index Journal Citation Report—1997. Table 1 lists the impact factor of all journals included in the questionnaire or those mentioned by respondents.
RESULTS A total of 418 surgeons responded to the survey; 47 responses were excluded because of incomplete entry into the questionnaire or the retirement status of the responding surgeons, leaving 371 responses for analysis (37%). General Characteristics of Respondents Their mean age was 52 years (range, 32 to 81) and 348 (92%) were male. They were in active surgical practice, after residency, for an average of 19.7 years (range, 3 to 40). Most, 221 surgeons, practiced in urban areas. One hundred and five surgeons practiced in university/medical school setting, whereas the rest practiced in the “community.”
TABLE 1 Journals impact factors Journal
Impact factors
New Eng J Med Lancet Gastroenterology JAMA Annals of Surgery BMJ Critical Care Medicine Cancer J Vascular Surgery Archives of Surgery British J Surgery Current Problems in Surgery World J Surgery Surgery Diseases of Colon & Rectum Surgical Endoscopy & US Mayo Clin Proc American J Surgery J American College of Surgeons Surgical Clinics of North America J Trauma J Surgical Oncology American Surgeon Surgical Laparoscopy & Endoscopy J Laparoendoscopic Surgery Ann Royal Coll Surg England European J Surgery Canadian J Surgery Australian NZ J Surgery International Surgery Digestive Surgery Vascular Surgery Contemporary Surgery Current Surgery Surgical Rounds Advances in Surgery Problems in General Surgery Selected Readings in General Surgery Year Book of Surgery
28.66 11.79 10.33 9.55 5.4 5.32 3.74 3.66 2.67 2.53 2.38 2.37 2.27 2.24 2.13 2.1 1.98 1.87 1.87 1.74 1.44 1.02 0.99 0.97 0.97 0.83 0.79 0.57 0.54 0.39 0.27 0.20 — — — — — — —
Number of Publications
Preferred Reading Material
The number of publications written hitherto by the individual respondents varied from 0 to 450, mean, 30 and median, 6 publications per surgeon. Fifteen percent of respondents never publish a paper, and 40% have published more than 10 papers (Fig. 1).
Surgeons prefer peer-reviewed journals as their reading material, followed by textbooks and “update series” (Fig. 3). Peerreviewed journals remain “popular” as long as surgeons continue in practice. However, as surgeons spend more years in practice, they read fewer books and more free handout journals (p ⬍ 0.05; Fig. 4).
Reading Habits The average per surgeon time per month dedicated to medical literature was 14 hours, median, 10 hours (range, 1 to 120). Surgeons having published more than 10 papers read 9.4 hours more per month than those never publishing (p ⫽ 0.007). Source of Information Medical literature is the most favored source of information, followed by professional meetings and CME courses (Fig. 2). CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
Popularity of Journals The most popular “general” surgical journals, with their respective IFs, are illustrated in Figure 5. Annals of Surgery leads the list, followed by the Journal of the American College of Surgeons and the Archives of Surgery. Popular subspecialty journals, and their respective IFs, are depicted in Figure 6; Cancer, Critical Care Medicine, and Gastroenterology lead the list. Popular “general” medical journals appear in Figure 7; the 253
FIGURE 1. Surgeons with publications.
FIGURE 2. Source of information. LITE ⫽ medical literature; MEET ⫽ professional meetings; CME ⫽ continuous medical education; SRMD ⫽ senior medical colleagues; WEB ⫽ Internet; AUDI ⫽ audio; REPS ⫽ pharmaceutical representatives; VIDE ⫽ video.
FIGURE 3. Preferred reading material. PRJR ⫽ peer-reviewed journals; BOOK ⫽ textbooks; UPDT ⫽ update series; FRJR ⫽ free journals; WEB ⫽ Internet. 254
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
FIGURE 4. Preferred reading material. (A) Surgeons in practice 0 –5 years. (B) Surgeons in practice 6 –10 years. (C) Surgeons in practice 11–20 years. (D) Surgeons in practice 21–30 years. (E) Surgeons in practice 31– 40 years. (F) Surgeons in practice longer than 41 years. PRJR ⫽ peer-reviewed journals; BOOK ⫽ textbooks; UPDT ⫽ update series; FRJR ⫽ free journals; WEB ⫽ Internet.
New England Journal of Medicine and the Journal of the American Medical Association lead the list.
DISCUSSION American surgeons are exposed to a virtually unlimited quantity of medical information. To our knowledge, this study is the first attempt to poll American surgeons about which sources of information they prefer. Published literature, especially peer reviewed, is their top choice, followed by professional meetings and CME courses. Peer-reviewed journals are the preferred reading material, followed by textbooks and update series. The more time surgeons spend in practice, the less likely they are to
FIGURE 5. Popular surgical journals (impact factors). First, second, and third choices combined. CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
read books and the more likely they are to read free handout journals. Most respondents read professional journals, but which ones do they like best? Annals of Surgery was selected as number 1, followed by the Journal of the American College of Surgeons, Archives of Surgery, American Journal of Surgery, and Surgery. Two “update series” followed the latter “top-five”: Surgical Clinics of North America and Selected Readings in Surgery. The “top five” list of subspecialty journals chosen by the surgeons included Cancer, Critical Care Medicine, Gastroenterology, Journal of Vascular Surgery, and Journal of Trauma. As their favorite “general” medical journals, 67% of the respondents selected the New England Journal of Medicine and 66% selected the Journal of the American Medical Association, with the Mayo Clinic Proceedings, the Lancet, and the British Medical Journal lagging far behind. The IF published in the Science Citation Index, defined as the mean number of citations from a specific journal divided by the number of articles published by the journal during a period of 2 years, is widely used in the scientific community to measure the relative “importance” of a medical journal. Whether the IF objectively assesses the scientific quality of journals and its articles is the subject of an ongoing debate, which is beyond the scope of this work. Whether the impact factor has any impact on readers has received hitherto little attention. In a Chinese study of library journal use, a significant correlation existed between frequency of use and citation frequency and between 255
FIGURE 6. Popular subspecialty journals (impact factors). First, second, and third choices combined. CANC ⫽ Cancer; CCM ⫽ Critical Care Medicine; GASTR ⫽ Gastroenterology; JVS ⫽ Journal of Vascular Surgery; J TR ⫽ Journal of Trauma; JSO ⫽ Journal of Surgical Oncology; TRANS ⫽ Transplantation; SLE ⫽ Surgery Laparoscopy & Endoscopy; DCR ⫽ Diseases of the Colon & Rectum.
frequency of use and impact.2 An assessment of journal use at a Chicago medical library found that certain journals may be popular to the general reader for educational and clinical purposes, but not to the local faculty for research purposes.3 Does the IF of individual journals correlate with the “importance” attributed to it by surgeons? It appears that this is only partially so, and with notable biases. The Annals of Surgery, which is the highest-ranking surgical journal on the IF list (IF, 5.40) is also the most “popular” among the responding surgeons. The Journal of the American College of Surgeons, the second on the “popularity” list, however, has an IF of only 1.87, whereas Surgery, with a higher IF (IF, 2.24), is lagging behind. Clearly, other factors than the IF influence the “popularity” of journals among surgeons. For instance, all Fellows of the American College of Surgeons are automatically subscribed to the Journal of the American College of Surgeons, whereas members of
the American Medical Association routinely receive Archives of Surgery and Journal of the American Medical Association. Consequently, journals of high IF, which are not “enforced” on the reader, may suffer in “popularity.” That this consequence may be the case is suggested by the preferences of the surgeons concerning general medical journals. Journal of the American Medical Association (IF, 9.55) was as popular as the New England Journal of Medicine, which has the highest IF (IF, 28.66). On the other hand, Lancet, which is a highly prestigious international journal (IF, 11.79) was scored by the surgeons well behind the Journal of the American Medical Association (IF, 9.55) and the Mayo Clinic Proceedings (IF, 1.98). Notably, the British Journal of Surgery (Br J Surg)—the only non-American general surgical journal with an IF (2.38) that could have placed it among the “top-five” of the list (Fig. 5)— has been chosen only by a few American respondents. In con-
FIGURE 7. Popular general medical journals (impact factors). First, second, and third choices combined. NEJM ⫽ New England Journal of Medicine; JAMA ⫽ Journal of the American Medical Association; MCPR ⫽ Mayo Clinic Proceedings; LANC ⫽ Lancet; BMJ ⫽ British Medical Journal. 256
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
trast, a recent e-mail audit conducted by us of members of SURGINET, an international general surgical Internet discussion list,4 disclosed a different picture. To the question of which is the “best” general surgical journal in the world, 33% of respondents selected British Journal of Surgery, followed by Annals of Surgery, which was considered the best by 20%, Journal of the American College of Surgeons, considered the best by 19%, and Archives of Surgery, considered the best by 8%(unpublished results). Interestingly, despite the great enthusiasm and “hype” surrounding the Internet, only 25% of respondents used it as a source for information. It may well be that the 418 (out of 1000) respondents to this poll, bothering to complete a rather lengthy questionnaire, represent a self-selected group of “literary” surgeons seeking information and reading more than the nonrespondents, about whom we know nothing. Be that as it may, it is possible to conclude that those American surgeons having responded consider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non–
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
United States publications and select the journals they read without considering its IF.
REFERENCES 1. Arndt KA. Information excess in medicine. Overview, rel-
evance to dermatology, and strategies for coping. Arch Dermatol 1992;128:1249 –1256. 2. Tsay MY. The relationship between journal use in a med-
ical library and citation use. Bull Med Libr Assoc 1998;86: 31–39. 3. Blecic DD. Measurements of journal use: an analysis of the
correlations between three methods. Bull Med Libr Assoc 1999;871:20 –25. 4. Gilas T, Schein M, Frykberg E. A surgical Internet discus-
sion list (Surginet): a novel venue for international communication among surgeons. Arch Surg 1998;133:1126 – 1130.
257
APPENDIX 1. What surgeons read questionnaire. 1. Physician Data: Age/Sex:
Years in practice after residency:
2. Type of Practice: Rural/urban: Teaching/nonteaching: Secondary specialty:
Community/university setting: Primary specialty:
3. Your faculty range–if any: Full-time/part-time:
Prof/Assoc/Assist/Other:
4. Number of your publications if any: 5. How many hours a month do you spend reading medical/surgical literature? 6. What do you read? e e e e e e e
Textbooks (eg, Schwartz’s Principles of Surgery) Peer-reviewed journals (e.g., Annals of Surgery) Update series (eg, Surgical Clinics of North America) Commercial-industry sponsored ‘‘hand-out’’ journals Internet sources (eg, National Institutes of Health web-site, Physician online) I listen to audiocassettes (eg, Einstein’s review tapes) Others: please name
7. How important are the following sources of information to you? e e e e e e e e
Senior MD Colleagues Medical literature, library Professional meetings Continuous medical education courses Pharmaceutical ‘‘reps’’ Audio tapes Television, videotapes Others: please name
8. What are the surgical journals you read? [Please mark ‘‘X’’ in the box before the journal you read and name the other journals you read if not listed below.] e e e e e e e e e e e e e e e e e e e e
e e e e e e e e e e e e e e e e e e e e
American J Surgery American Surgeon Annals of Surgery Archives of Surgery Contemporary Surgery Current Surgery International Surgery J American College of Surgeons Surgical Rounds Surgery World J Surgery Others: please name Advances in Surgery Current Problems in Surgery Problems in General Surgery Selected Readings in General Surgery Surgical Clinics of North America Year Book of Surgery
Ann Royal Coll Surg Edinburgh Ann Royal Coll Surg England Australian NZ J Surgery British J Surgery Canadian J Surgery European J Surgery Digestive Surgery Diseases of Colon & Rectum J Laparoendoscopic Surgery J Surgical Oncology J Trauma J Vascular Surgery Surgical Endoscopy Surgical Laparoscopy & Endoscopy Vascular Surgery Others: please name
9. I consider the following as the best surgical journals (1 ⫽ your first choice, 2 ⫽ your second, 3 ⫽ your third choice): 1.
2.
3.
10. What are the subspecialty journals (nonsurgical specialty) you read regularly? (eg, Gastroenterology, Cancer, Critical Care Medicine) 1.
2.
3.
11. What are the general medical journals you read regularly? (eg, BMJ, JAMA, Lancet, New Eng J Med, Mayo Clin Proc) 1. 258
2.
3. CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
What American Surgeons Read: A Survey of a Thousand Fellows of the American College of Surgeons Moshe Schein, MD, Ramesh Paladugu, MD, Vesna G. Sutija, PhD, and Leslie Wise, MD Department of Surgery, New York Methodist Hospital and Cornell University Medical College, Brooklyn, New York PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are “popular,” and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the “popularity” of journals with their IFs. METHODS: A questionnaire was mailed to 1000 American
surgeons, randomly selected from a list provided by the American College of Surgeons. RESULTS: A total of 418 surgeons responded, and 371 re-
sponses could be analyzed (37%). The leading sources of medical information were medical literature (93%), professional meetings (88%), and CME courses (69%). The average time per surgeon/month dedicated to medical literature was 14 hours (range, 1 to 120). Peer-reviewed journals were read by 95%, textbooks by 68%, and update series by 60% of the respondents. The three most popular surgical journals were Annals of Surgery (IF, 5.40), selected by 60%; Journal of the American College of Surgery (IF, 1.87), selected by 48%; and Archives of Surgery (IF, 2.53), selected by 36%. The most popular subspecialty journals were Cancer (IF, 3.66), selected by 31%; Critical Care Medicine (IF, 3.74), selected by 17%; and Gastroenterology (IF, 10.33), selected by 12%. The New England Journal of Medicine (IF, 28.66), selected by 67%, and the Journal of the American Medical Association (IF, 9.55), selected by 66%, were the most popular general medical journals, followed by Mayo Clinic Proceedings (IF, 1.98), selected by 16%. Among the “leaders” on the IF list for international, British medical and surgical journals were Lancet (IF, 11.79), selected by 5%, and
Correspondence: Inquiries to Moshe Schein, MD, Department of Surgery, New York Methodist Hospital, 506 Sixth St, Brooklyn, NY 11215; fax: (718) 780 3154; e-mail: [email protected]
252
British Journal of Surgery (IF, 2.38), selected by 0.5% of the respondents. CONCLUSIONS: Those American surgeons responding con-
sider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non– United States publications and select the journals they read without considering its IF. (Curr Surg 2000;57:252–258. © 2000 by the Association of Program Directors in Surgery.) KEY WORDS: CME, surgical education, surgical literature,
impact factor, surgical journals
INTRODUCTION Modern American surgeons, together with their colleagues in other specialties, are immersed in an ever-deepening sea of printed and electronic information.1 Over 4000 medical journals, in 40 languages, are currently published around the world. Fifty-two percent of these journals are published in the United States. Eighty eight percent of all published articles are in English. MEDLINE files contain over 9.2-million bibliographic citations and abstract records; a total of 31,000 new citations are added each month. The National Library of Medicine lists a total of 669 surgical journals,201 of which are “indexed” and cited by Index Medicus and its counterparts. A search using the key word “surgery” through the Internet bookshop websites, such as Amazon.com or barnesandnoble.com, disclosed 7658 and 5170 books, respectively (on March 27, 1999). Over 5000 professional medical links are available on the Internet. Add to this material national and international conferences, courses, and institutional CME events. Who has the time to read? Although publishers know how many journals and books they publish and sell, and journals can quote their calculated impact factor (IF), citation half-life, and other parameters, no information exists whatsoever about what surgeons read and how much. It is also unclear whether surgeons prefer journals ranking highly on the IF list. To explore which information
CURRENT SURGERY • © 2000 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/00/$20.00 PII S0149-7944(00)00177-X
sources surgeons currently rely on, and which journals they prefer, we initiated this study.
METHODS A questionnaire was mailed to 1000 American surgeons, randomly selected from a list provided by the American College of Surgeons. The entire questionnaire is reproduced in Appendix 1. “Popularity” of a journal was measured as the percent of times it was mentioned as a first, second, or third choice. A database was generated from valid survey responses. The statistical analyses were performed by SPSS software (SPSS Inc., Chicago). The relationship between continuous variables was assessed with t tests and the analysis of variance (ANOVA). The relationships among categorical variables were evaluated by 2 (chi-square). A Spearman correlation coefficient was used with ranked variables. All comparisons included any cases with valid data. An ␣ ⫽ 0.05 was considered statistically significant. The IF of the various journals was retrieved from the Science Citation Index Journal Citation Report—1997. Table 1 lists the impact factor of all journals included in the questionnaire or those mentioned by respondents.
RESULTS A total of 418 surgeons responded to the survey; 47 responses were excluded because of incomplete entry into the questionnaire or the retirement status of the responding surgeons, leaving 371 responses for analysis (37%). General Characteristics of Respondents Their mean age was 52 years (range, 32 to 81) and 348 (92%) were male. They were in active surgical practice, after residency, for an average of 19.7 years (range, 3 to 40). Most, 221 surgeons, practiced in urban areas. One hundred and five surgeons practiced in university/medical school setting, whereas the rest practiced in the “community.”
TABLE 1 Journals impact factors Journal
Impact factors
New Eng J Med Lancet Gastroenterology JAMA Annals of Surgery BMJ Critical Care Medicine Cancer J Vascular Surgery Archives of Surgery British J Surgery Current Problems in Surgery World J Surgery Surgery Diseases of Colon & Rectum Surgical Endoscopy & US Mayo Clin Proc American J Surgery J American College of Surgeons Surgical Clinics of North America J Trauma J Surgical Oncology American Surgeon Surgical Laparoscopy & Endoscopy J Laparoendoscopic Surgery Ann Royal Coll Surg England European J Surgery Canadian J Surgery Australian NZ J Surgery International Surgery Digestive Surgery Vascular Surgery Contemporary Surgery Current Surgery Surgical Rounds Advances in Surgery Problems in General Surgery Selected Readings in General Surgery Year Book of Surgery
28.66 11.79 10.33 9.55 5.4 5.32 3.74 3.66 2.67 2.53 2.38 2.37 2.27 2.24 2.13 2.1 1.98 1.87 1.87 1.74 1.44 1.02 0.99 0.97 0.97 0.83 0.79 0.57 0.54 0.39 0.27 0.20 — — — — — — —
Number of Publications
Preferred Reading Material
The number of publications written hitherto by the individual respondents varied from 0 to 450, mean, 30 and median, 6 publications per surgeon. Fifteen percent of respondents never publish a paper, and 40% have published more than 10 papers (Fig. 1).
Surgeons prefer peer-reviewed journals as their reading material, followed by textbooks and “update series” (Fig. 3). Peerreviewed journals remain “popular” as long as surgeons continue in practice. However, as surgeons spend more years in practice, they read fewer books and more free handout journals (p ⬍ 0.05; Fig. 4).
Reading Habits The average per surgeon time per month dedicated to medical literature was 14 hours, median, 10 hours (range, 1 to 120). Surgeons having published more than 10 papers read 9.4 hours more per month than those never publishing (p ⫽ 0.007). Source of Information Medical literature is the most favored source of information, followed by professional meetings and CME courses (Fig. 2). CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
Popularity of Journals The most popular “general” surgical journals, with their respective IFs, are illustrated in Figure 5. Annals of Surgery leads the list, followed by the Journal of the American College of Surgeons and the Archives of Surgery. Popular subspecialty journals, and their respective IFs, are depicted in Figure 6; Cancer, Critical Care Medicine, and Gastroenterology lead the list. Popular “general” medical journals appear in Figure 7; the 253
FIGURE 1. Surgeons with publications.
FIGURE 2. Source of information. LITE ⫽ medical literature; MEET ⫽ professional meetings; CME ⫽ continuous medical education; SRMD ⫽ senior medical colleagues; WEB ⫽ Internet; AUDI ⫽ audio; REPS ⫽ pharmaceutical representatives; VIDE ⫽ video.
FIGURE 3. Preferred reading material. PRJR ⫽ peer-reviewed journals; BOOK ⫽ textbooks; UPDT ⫽ update series; FRJR ⫽ free journals; WEB ⫽ Internet. 254
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
FIGURE 4. Preferred reading material. (A) Surgeons in practice 0 –5 years. (B) Surgeons in practice 6 –10 years. (C) Surgeons in practice 11–20 years. (D) Surgeons in practice 21–30 years. (E) Surgeons in practice 31– 40 years. (F) Surgeons in practice longer than 41 years. PRJR ⫽ peer-reviewed journals; BOOK ⫽ textbooks; UPDT ⫽ update series; FRJR ⫽ free journals; WEB ⫽ Internet.
New England Journal of Medicine and the Journal of the American Medical Association lead the list.
DISCUSSION American surgeons are exposed to a virtually unlimited quantity of medical information. To our knowledge, this study is the first attempt to poll American surgeons about which sources of information they prefer. Published literature, especially peer reviewed, is their top choice, followed by professional meetings and CME courses. Peer-reviewed journals are the preferred reading material, followed by textbooks and update series. The more time surgeons spend in practice, the less likely they are to
FIGURE 5. Popular surgical journals (impact factors). First, second, and third choices combined. CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
read books and the more likely they are to read free handout journals. Most respondents read professional journals, but which ones do they like best? Annals of Surgery was selected as number 1, followed by the Journal of the American College of Surgeons, Archives of Surgery, American Journal of Surgery, and Surgery. Two “update series” followed the latter “top-five”: Surgical Clinics of North America and Selected Readings in Surgery. The “top five” list of subspecialty journals chosen by the surgeons included Cancer, Critical Care Medicine, Gastroenterology, Journal of Vascular Surgery, and Journal of Trauma. As their favorite “general” medical journals, 67% of the respondents selected the New England Journal of Medicine and 66% selected the Journal of the American Medical Association, with the Mayo Clinic Proceedings, the Lancet, and the British Medical Journal lagging far behind. The IF published in the Science Citation Index, defined as the mean number of citations from a specific journal divided by the number of articles published by the journal during a period of 2 years, is widely used in the scientific community to measure the relative “importance” of a medical journal. Whether the IF objectively assesses the scientific quality of journals and its articles is the subject of an ongoing debate, which is beyond the scope of this work. Whether the impact factor has any impact on readers has received hitherto little attention. In a Chinese study of library journal use, a significant correlation existed between frequency of use and citation frequency and between 255
FIGURE 6. Popular subspecialty journals (impact factors). First, second, and third choices combined. CANC ⫽ Cancer; CCM ⫽ Critical Care Medicine; GASTR ⫽ Gastroenterology; JVS ⫽ Journal of Vascular Surgery; J TR ⫽ Journal of Trauma; JSO ⫽ Journal of Surgical Oncology; TRANS ⫽ Transplantation; SLE ⫽ Surgery Laparoscopy & Endoscopy; DCR ⫽ Diseases of the Colon & Rectum.
frequency of use and impact.2 An assessment of journal use at a Chicago medical library found that certain journals may be popular to the general reader for educational and clinical purposes, but not to the local faculty for research purposes.3 Does the IF of individual journals correlate with the “importance” attributed to it by surgeons? It appears that this is only partially so, and with notable biases. The Annals of Surgery, which is the highest-ranking surgical journal on the IF list (IF, 5.40) is also the most “popular” among the responding surgeons. The Journal of the American College of Surgeons, the second on the “popularity” list, however, has an IF of only 1.87, whereas Surgery, with a higher IF (IF, 2.24), is lagging behind. Clearly, other factors than the IF influence the “popularity” of journals among surgeons. For instance, all Fellows of the American College of Surgeons are automatically subscribed to the Journal of the American College of Surgeons, whereas members of
the American Medical Association routinely receive Archives of Surgery and Journal of the American Medical Association. Consequently, journals of high IF, which are not “enforced” on the reader, may suffer in “popularity.” That this consequence may be the case is suggested by the preferences of the surgeons concerning general medical journals. Journal of the American Medical Association (IF, 9.55) was as popular as the New England Journal of Medicine, which has the highest IF (IF, 28.66). On the other hand, Lancet, which is a highly prestigious international journal (IF, 11.79) was scored by the surgeons well behind the Journal of the American Medical Association (IF, 9.55) and the Mayo Clinic Proceedings (IF, 1.98). Notably, the British Journal of Surgery (Br J Surg)—the only non-American general surgical journal with an IF (2.38) that could have placed it among the “top-five” of the list (Fig. 5)— has been chosen only by a few American respondents. In con-
FIGURE 7. Popular general medical journals (impact factors). First, second, and third choices combined. NEJM ⫽ New England Journal of Medicine; JAMA ⫽ Journal of the American Medical Association; MCPR ⫽ Mayo Clinic Proceedings; LANC ⫽ Lancet; BMJ ⫽ British Medical Journal. 256
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
trast, a recent e-mail audit conducted by us of members of SURGINET, an international general surgical Internet discussion list,4 disclosed a different picture. To the question of which is the “best” general surgical journal in the world, 33% of respondents selected British Journal of Surgery, followed by Annals of Surgery, which was considered the best by 20%, Journal of the American College of Surgeons, considered the best by 19%, and Archives of Surgery, considered the best by 8%(unpublished results). Interestingly, despite the great enthusiasm and “hype” surrounding the Internet, only 25% of respondents used it as a source for information. It may well be that the 418 (out of 1000) respondents to this poll, bothering to complete a rather lengthy questionnaire, represent a self-selected group of “literary” surgeons seeking information and reading more than the nonrespondents, about whom we know nothing. Be that as it may, it is possible to conclude that those American surgeons having responded consider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non–
CURRENT SURGERY • Volume 57/Number 3 • May/June 2000
United States publications and select the journals they read without considering its IF.
REFERENCES 1. Arndt KA. Information excess in medicine. Overview, rel-
evance to dermatology, and strategies for coping. Arch Dermatol 1992;128:1249 –1256. 2. Tsay MY. The relationship between journal use in a med-
ical library and citation use. Bull Med Libr Assoc 1998;86: 31–39. 3. Blecic DD. Measurements of journal use: an analysis of the
correlations between three methods. Bull Med Libr Assoc 1999;871:20 –25. 4. Gilas T, Schein M, Frykberg E. A surgical Internet discus-
sion list (Surginet): a novel venue for international communication among surgeons. Arch Surg 1998;133:1126 – 1130.
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APPENDIX 1. What surgeons read questionnaire. 1. Physician Data: Age/Sex:
Years in practice after residency:
2. Type of Practice: Rural/urban: Teaching/nonteaching: Secondary specialty:
Community/university setting: Primary specialty:
3. Your faculty range–if any: Full-time/part-time:
Prof/Assoc/Assist/Other:
4. Number of your publications if any: 5. How many hours a month do you spend reading medical/surgical literature? 6. What do you read? e e e e e e e
Textbooks (eg, Schwartz’s Principles of Surgery) Peer-reviewed journals (e.g., Annals of Surgery) Update series (eg, Surgical Clinics of North America) Commercial-industry sponsored ‘‘hand-out’’ journals Internet sources (eg, National Institutes of Health web-site, Physician online) I listen to audiocassettes (eg, Einstein’s review tapes) Others: please name
7. How important are the following sources of information to you? e e e e e e e e
Senior MD Colleagues Medical literature, library Professional meetings Continuous medical education courses Pharmaceutical ‘‘reps’’ Audio tapes Television, videotapes Others: please name
8. What are the surgical journals you read? [Please mark ‘‘X’’ in the box before the journal you read and name the other journals you read if not listed below.] e e e e e e e e e e e e e e e e e e e e
e e e e e e e e e e e e e e e e e e e e
American J Surgery American Surgeon Annals of Surgery Archives of Surgery Contemporary Surgery Current Surgery International Surgery J American College of Surgeons Surgical Rounds Surgery World J Surgery Others: please name Advances in Surgery Current Problems in Surgery Problems in General Surgery Selected Readings in General Surgery Surgical Clinics of North America Year Book of Surgery
Ann Royal Coll Surg Edinburgh Ann Royal Coll Surg England Australian NZ J Surgery British J Surgery Canadian J Surgery European J Surgery Digestive Surgery Diseases of Colon & Rectum J Laparoendoscopic Surgery J Surgical Oncology J Trauma J Vascular Surgery Surgical Endoscopy Surgical Laparoscopy & Endoscopy Vascular Surgery Others: please name
9. I consider the following as the best surgical journals (1 ⫽ your first choice, 2 ⫽ your second, 3 ⫽ your third choice): 1.
2.
3.
10. What are the subspecialty journals (nonsurgical specialty) you read regularly? (eg, Gastroenterology, Cancer, Critical Care Medicine) 1.
2.
3.
11. What are the general medical journals you read regularly? (eg, BMJ, JAMA, Lancet, New Eng J Med, Mayo Clin Proc) 1. 258
2.
3. CURRENT SURGERY • Volume 57/Number 3 • May/June 2000