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Why a Journal of Hand Surgery? II
Editorial Why a Journal of Hand Surgery? II Joseph Boyes, in the inaugural editorial of The Journal of Hand Surgery (reprinted on the previous pages), addressed the question “Why a Journal of Hand Surgery?” by noting that published articles concerning the hand were scattered in various textbooks, societal transaction papers, and tissue-oriented periodicals. Although hand surgery had met many of its educational obligations as an established medical discipline, such as sponsoring meetings and courses related to the upper extremity, defining requirements for fellowship training, and publishing a continuously updated bibliography of hand surgery, these activities alone were not sufficient to fulfill hand surgery’s educational mission. A specialty journal devoted exclusively to the upper limb was needed to accomplish its commitment “to improve and develop surgery of the hand.” By all standards, the publication established by Dr Boyes and his founding colleagues has been successful. Nevertheless, the question “Why a Journal of Hand Surgery?” is still pertinent today. It begs, however, a more expanded response, one that focuses not on explaining the need for such a journal, but rather on what we have come to expect of it; that is, what is its purpose and what are its objectives? As envisioned by Dr Boyes, the Journal serves as a principal repository for thoughts and ideas related to surgery of the hand. The 3,804 published articles are the historical record—the archives, so to speak— of the development of our specialty, the authority to which students of hand surgery turn for information. Some proved to be longlasting, some have been modified by ensuing notations and entries, and some became mere footnotes in the ongoing chronicles of hand surgery. Nevertheless, all are essential to defining what hand surgery is and what it will become. Additionally, The Journal of Hand Surgery provides a forum for authors to present new ideas and concepts. From a retrospective view point, ideas that have endured include the development of a classification system to categorize congenital anomalies, the identification of different patterns of carpal bone instability, the importance of tendon mobilization in the rehabilitation of sutured flexor tendons, the use of tubulization to restore continuity to injured peripheral nerves, and the microvascular transfer of composite tissues. Few ideas, however, remain unaltered; most are expanded on, clarified, or even rebutted by subsequent publications. In contrast to textbooks, review articles, and monographs, journal articles represent “current” data and do not enjoy the luxury of being shaped by the reflective perspective of time. No idea is forever and no concept is absolute; all will in time be altered by subsequent information and the presentation of new data. A third principal objective, and perhaps the most important, is to educate the reader. As noted in a 1994 ASSH member survey, The Journal of Hand Surgery is the hand surgeon’s most important instrument in addressing continuing medical education needs, exceeding even that of the annual meeting. At the most basic level, The Journal of Hand Surgery 3
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the reader incorporates published data and conclusions into his or her clinical algorithms. At a higher level, the surgeon obtains a more complete understanding of the condition or disease even if the information is not directly applied to patient care. At the most sophisticated level, an article stimulates independent ideas that are only tangentially related to the published material; a kernel of thought is planted and germinates along a completely different line. Although many of these nascent ideas never make it to print, they serve to enrich the hand surgeon’s professional life as a clinician, educator, and student. Finally, the Journal serves to enhance critical thinking. This is most evident, for example, during journal club discussions, but also can be experienced by the surgeon individually. In considering the article’s message, the discussion frequently digresses to a critical review of its merits and an exercise in detecting flaws—flaws in design, presentation, interpretation, or relative importance. In effect, the discussants assume the critiquing role of a peer reviewer. As the manuscript is simultaneously picked and nit-picked, pummeled and praised, excoriated and extolled, it serves as a whetstone on which the cutting edge of critical thinking is sharpened and honed, a necessary element to the professional growth of the surgeon and to the maturation of the discipline. As the Journal celebrates the completion of the first quarter century, it is mindful of its responsibility to continue to be a principal element in the education and development of hand surgery. By its very nature, it must be dynamic rather than static. It must stimulate controversy rather than promote consent, recognizing that these two apparently dissimilar entities can nonetheless be harmonious. The give and take, ebb and flow of expressed ideas are its life blood and essential to its vitality. The purpose of the Journal is not to publish the “perfect” paper; in point of fact, there probably are none. No manuscript is without flaw. No article is without detractors and none is universally accepted. Discrepancies in reader acceptance reflect the different needs and expectations of the constituency. Rather, the purpose of the Journal is to add incremental building blocks of information to our wall of scientific knowledge. P.R.M.
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the reader incorporates published data and conclusions into his or her clinical algorithms. At a higher level, the surgeon obtains a more complete understanding of the condition or disease even if the information is not directly applied to patient care. At the most sophisticated level, an article stimulates independent ideas that are only tangentially related to the published material; a kernel of thought is planted and germinates along a completely different line. Although many of these nascent ideas never make it to print, they serve to enrich the hand surgeon’s professional life as a clinician, educator, and student. Finally, the Journal serves to enhance critical thinking. This is most evident, for example, during journal club discussions, but also can be experienced by the surgeon individually. In considering the article’s message, the discussion frequently digresses to a critical review of its merits and an exercise in detecting flaws—flaws in design, presentation, interpretation, or relative importance. In effect, the discussants assume the critiquing role of a peer reviewer. As the manuscript is simultaneously picked and nit-picked, pummeled and praised, excoriated and extolled, it serves as a whetstone on which the cutting edge of critical thinking is sharpened and honed, a necessary element to the professional growth of the surgeon and to the maturation of the discipline. As the Journal celebrates the completion of the first quarter century, it is mindful of its responsibility to continue to be a principal element in the education and development of hand surgery. By its very nature, it must be dynamic rather than static. It must stimulate controversy rather than promote consent, recognizing that these two apparently dissimilar entities can nonetheless be harmonious. The give and take, ebb and flow of expressed ideas are its life blood and essential to its vitality. The purpose of the Journal is not to publish the “perfect” paper; in point of fact, there probably are none. No manuscript is without flaw. No article is without detractors and none is universally accepted. Discrepancies in reader acceptance reflect the different needs and expectations of the constituency. Rather, the purpose of the Journal is to add incremental building blocks of information to our wall of scientific knowledge. P.R.M.