Publication should not be the endgame of medical research

Abraar Karan

Published on March 1, 2017

“How many publications do I need to get into medical school?” If I could count the number of times a mentee has asked me this question, I would have enough data for a robust research study. “How many publications do I need to get into residency?” If I had a publication for every time I overheard someone in my medical school ask this, I would probably be a tenured professor.

It is well known that research is a fundamental part of medical education in the US, UK, and other parts of the world, and it absolutely should be—the benefits of research in medical care couldn’t be overstated. However, while medical students are constantly encouraged to publish academic work, they are rarely instilled with the value of what the potential impact of that work could be.

Often, this results in students having little interest in continuing research careers after medical school, although most are still advised to say that they are “interested” in research when interviewing for medical residency. Without the right motivation, I believe that research is at worst becoming a shortsighted, insincere effort—really a means for medical students to land prestigious residency spots. And at best, research is failing to meet its full potential of instilling passion in future physicians to use it for meaningful advancement of the profession.

One of the major problems with research is that most publications are left unread, uncited, or unused, which in many ways results in an anticlimactic ending after a paper has been published. Current estimates of how many people actually read medical research papers are relatively uncertain—a running academic joke is that less than half of academic work is read by anyone other than the author and the editor that reviewed it.

But perhaps it’s not too far from the truth, at least with regards to medical students’ papers. A study in BMC Medical Education found that the majority of research papers written by medical students had never been subsequently cited by any other researchers. While this might seem disheartening, it is really a symptom of an important mismatch between how people consume information today (our attention spans are shortening, quickly) and how we present, advocate for, and translate the final research papers that we publish into something more.

Frankly, publishing a research paper cannot be seen as the endgame of research. It is equally important to advocate for one’s paper through public promotion. Today, this can be done through a number of non-traditional avenues, including social media, such as Twitter, Facebook, and LinkedIn. Through these, it is possible to create viral movements around research findings—an avenue of publicity that has been very poorly explored or attempted.

Social media has in some ways created a potential equalizer for research dissemination—good quality papers in less well known journals can still gain traction. Where a paper is published is in many ways less important to how many people read it than how adamant the author is to advocate for their work in the above ways.

One of the key messages that medical students are often told by research mentors is that publications should be in journals that are indexed in PubMed. If they aren’t, the quality of the journal is likely unreliable and the publication doesn’t hold quite the same academic weight, or so they are told.

However, the reality is that there continues to be a growing number of journals that are indexed in PubMed every year, nearly 500 as reported by the US National Library of Medicine, and it is very difficult to oversee the quality of the papers being published in each of these. A number of these journals become the homes of papers that otherwise were not accepted to more prestigious outlets for lack of relevance or quality. By developing a medical education system that is so focused on the number of papers students publish (when applying to medical residency in the US, one of the main recorded metrics is “number of papers/abstracts/publications”), we are creating the wrong incentives for carrying out research studies, which are increasingly being published for the sake of being published and little else.

The reality is that many of us have likely questioned what the purpose of our research truly is. I’m confident that I’m not alone in having predicted that the findings of my research would end up supporting a hypothesis that I was essentially certain of prior to its undertaking.

For instance, as a first year student in college, I conducted a research study—a randomized controlled trial—investigating whether using multimedia aids would improve the understanding of informed consent for cataract surgery among illiterate villagers in India, compared to the “gold standard” informed consent procedure in which a medical staff member read the consent aloud. I was pretty sure even before the study that with additional time and effort through multimedia, these patients would understand the consent process better than they would from simply hearing a staff member mundanely read the consent procedure from a piece of paper.

My research findings confirmed this hypothesis, and my paper was eventually published nearly two years after conducting this study in the Indian Journal of Ophthalmology. The process was certainly important in teaching me about research methods, but what if I had simply started producing multimedia diagrams for these patients? Was a study really needed to tell me what is seemingly common sense: that using more intricate learning materials and spending more time with people would improve understanding of difficult concepts? Sometimes, the time trade-off between conducting research versus simply acting on intuition can be difficult to reconcile.

Research is a fundamental component of medical advancement and it is without a doubt quintessential to the profession. I have the utmost respect for medical researchers, and I often do read the biggest research studies that are published in well known medical journals. For other research pieces, I’ll usually at least read the abstract and methods, if not the whole paper.

Having the right motivation for students to pursue research is important and should not be taken for granted. As medical educators, we must better understand how to make research more readable, digestible, and simply more fun. A new movement in visual demonstration of medical research abstracts, known fondly as #VisualAbstract on Twitter, is starting to build excitement and bring color to the medical research world. More efforts such as this are greatly needed.

If we expect students to care about the research they publish, we must care about making the products of that research more relevant and engaging.

 

(Abraar Karan is a physician at the Harvard TH Chan School of Public Health in the Department of Health Policy and Management.)

 

 

 

 

 

(This article was first published at blogs.bmj.com and is being republished here with due permission.) 

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