Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Title: Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Short title: Publish or Perish

Authors: P.A.G Torrie, J.R Berstock, E.B.S Hayward, G.C Bannister

Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB

Corresponding author: Mr P.A.G Torrie - Email – [email protected].

Authors’ addresses:

1. P.A.G Torrie – Trauma and Orthopaedic registrar – Severn Deanery. Flat 12, Muller House, Ashley

Down Road, Bristol, BS7 9DA.

2. J.R Berstock - Trauma and Orthopaedic registrar – Severn Deanery. First Floor Flat, 16 Durdham

Park, BS6 6XB.

3. E.B.S Hayward – Anaesthetics registrar – Severn Deanery. Flat 12, Muller House, Ashley Down

Road, Bristol, BS7 9DA.

4. G.C Bannister – Professor of Orthopaedics – Bristol. Avon Orthopaedic Centre, Southmead Hospital,

Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB.

1 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Abstract

The purposes of this study were to determine whether the senior author affects the probability of achieving a peer-reviewed publication and the effect the senior author has upon the quality of publication.

This is an observational study of all 54 orthopaedic registrars in one deanery. All papers identifiable on Pubmed by each registrar and their senior author were documented. Quality of paper was assessed by the impact factor of the research journal. Logistic regression was assessed using Spearman correlation for year of training vs. number of publications, number of publications vs. average number of senior author publications, average number of senior author publications vs. mean trainee impact factor score and number of publications vs. number of collaborative publications with current rotational registrar. P=0.05 was considered statistically significant.

Success rate and quality of trainees in peer-reviewed publication was highly significantly associated with their undertaking projects supervised by a senior author with a strong publication record (P=< 0.0001) and (P=0.0002) respectively. Collaboration with a fellow registrar was also highly significant (P=< 0.0001).

Trainees are more likely to achieve a quality peer-reviewed publication if they engage in research with a senior author with a strong publication record and collaborate with a fellow registrar.

2 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Introduction

Competition for a higher surgical national training number (NTN) and subsequent consultant post has always been high. Surgery continues to have the highest number of UK applicants per vacancy for entry to specialty training (Fazel 2009). The European working time directive (EWTD) has increased the number of junior trainees (Elbadrawy 2008) required to run on-call rotas and results in a reduction of about 30-35% of clinical and operative experience acquired during the usual 6 yrs of training (Benes 2006), which is further compounded by many fewer Specialist Registrar posts into which they can advance.

Furthermore the college’s medical workforce unit has shown that the proportion of CCT holders who achieved a substantive consultant post on qualification has dropped from 59.3% in 2009 to 55.7% in 2011

(Goddard 2011), with the estimated balance of supply and demand for surgical consultant posts to be balanced in 2012 (Royal College of Surgeons of England 2004) 5 thus leaving increasing numbers of orthopaedic surgeons with certificates of completion of training (CCT) but without consultant posts to enter. The prospective orthopaedic surgeon therefore now has two bottlenecks to negotiate and needs to identify objective discriminators that will help overcome both of these.

Peer-reviewed publications have always been a strong differentiator and an important prerequisite amongst surgical candidates applying at all grades (Dawson 1996; Evans 2007; Soyer 2011). With increasing competition amongst junior and middle grade trainees, there is an ever-growing expectation and requirement for publication (George 2009). 9 Currently Trauma and Orthopaedic trainees in our region are recommended by their ARCP panels to achieve at least one publication per year of training.

The aims of this study were to identify whether the choice of senior author affects a trainee’s chance of achieving a peer-reviewed publication, the quality of the publication and to identify whether the number of absolute publications when applying for consultancy has changed.

Methods

All the peer-reviewed publications on Pubmed of 54 registrars with a National Training Number on a Trauma and Orthopaedic rotation were recorded during the month of January 2012. The senior author on each identifiable trainee publications was also recorded. The total number of publications achieved by each senior author and trainee was then identified.

3 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Each trainee was then assigned an overall mean senior authors publication score. Determining all publications that each senior author on each of the registrar publications had produced that were identifiable on Pubmed derived this score. Then the sum of all of the senior author’s publications on each registrars identified publications was calculated. The total number of registrar publications then divided this sum, providing the mean senior authors publication score. E.g. Registrar 1 has 2 publications on Pubmed, the 2 seniors authors on each of the publications have 14 and 20 publications on Pubmed respectively. Therefore registrar 1 has a mean senior author publication score of 14+20 = 34/2, therefore 17.

Each trainee was also assigned a mean journal impact factor score, and this score was correlated with the mean senior author publication score. The aim was to determine whether trainees were more likely to publish in a more prestigious journal if they achieved publication with a senior author with a better publication track record. The quality of each trainee publication was established by identifying the impact factor (IF), as published in the Thomson Reuters Journal Citation Reports, for each trainee publication. Each trainee was then assigned a mean publication impact factor score. E.g. registrar 1 has 2 papers identified on

Pubmed. Paper 1 is published the annals of the Royal College of Surgeons of England and paper 2 is published in the Journal of Bone and Joint Surgery (Br), with impact factors of 1.093 and 2.351 respectively.

Registrar 1 mean impact publication impact factor score is therefore 1.093 + 2.351 = 1.722. This score was then correlated with the mean senior author publication score.

The number of publications with a concurrent rotational registrar colleague was identified for each trainee. The type of publication, grouped by orthopaedic subspecialty, was also determined. Similar data were collected on all current 33 trauma and orthopaedic consultants based in two rotational hospital trusts in the same deanery. One of the hospitals assessed was from the centre of the Deanery’s rotation and the second a peripheral hospital. The year of consultant appointment was identified. All consultant publications up to and including the year of consultant appointment were considered as publications related to their consultancy application. The number of publications subsequent to their year of appointment was also documented.

Data were analysed by logistic regression remodeling using the Spearman correlation to define the association between the numbers of registrar publications and the mean number of senior author publications and the number of collaborative rotational registrar publications and the number of consultant publications and their year of appointment to consultancy. Continuous non-parametric data were compared using Wilcoxon

4 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

rank sum test. We used the computer program GraphPad InStat 3 (San Diego, CA). The significance level was defined at a probability value less than 0.05.

Results

There were 54 Trauma and Orthopaedic registrars with national training numbers and 33 consultants. The 54

Trauma and Orthopaedic registrars had achieved 174 publications. Their mean number of publications was

3.26 and range 0-9. The mean number of publications prior to ST3 appointment was 1.24 (0-4). The mean number of publications achieved by collaboration with a fellow Trauma and Orthopaedic registrar was 1.22.

There was a statistically significant correlation between the year of training, the mean senior authors publication score, number of collaborative publications and the total number of registrar publications. There was no statistically significant correlation between the number of first author registrar publications and their year of training.

There was significance for the median number of senior author publications between the trainees. The median number of senior author publications was 16.5 amongst trainees with <5 and 46.2 amongst those with

>5 publications (Table 1). A statistically significant correlation was also established between the mean trainee impact factor score and the mean senior author publication score. Hip, shoulder and elbow and knee publications were the orthopaedic subspecialties that yielded the most trainee publications with 32, 24 and 21 publications respectively (Figure 1).

Among consultants assessed over a mean of 11.7 years since appointment (range 0-23), there were a total number of 453 publications identified on Pubmed. There were a mean total number of 13.73 publications amongst all consultants assessed, with a mean total number of publications of 9.92 and 16.2 at the peripheral and central hospitals respectively. The median number of publications prior to and after appointment to consultancy was 4 (range 0-13) and 7 (0-44) respectively. There was no significant association between the number of publications prior to consultant appointment and the year of appointment in the last 23 years. The median number of publications appointment to either a regional or central consultant post was 3 and 4.5 respectively. Although the median number of publications for a central hospital consultant appointment was higher than peripheral this was not statistically significant. The median number of publications after appointment to consultancy was 6 and 8.5 at the peripheral and central hospital respectively. This difference was not statistically significant (Table 2).

5 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Table 1: Trainee publication data

Correlation R value 95% Cist R squared P value

Year of training vs. no. of 0.28 0.0063 – 0.52 0.079 0.0394* publications Year of training vs. no. of 0.24 0.035 – 0.49 0.059 0.0775* 1st author publications No. of publications vs. 0.57 0.34 - 0.73 0.32 < 0.0001* average no. of publications by senior authors No. of publications vs. no. 0.52 0.29 - 0.70 0.27 < 0.0001* of papers collaborated on by fellow T+O registrars Difference between mean N/A N/A 0.0111** senior author number of <5 PRP 20.6 – 47.5 PRP in trainees with <5 >5PRP 29.8 – 83.9 and >5 PRP. Mean trainee publication 0.50 0.25 – 0.68 0.25 0.0002* Impact Factor score vs. average no. of publications by senior authors * Spearman correlation. R-values given were appropriate, ** Two tailed Wilcoxon rank sum test. PRP – Peer

Reviewed Publication.

Table 2: Consultant publication data

Correlation R value 95% Cist R squared P value

No. of consultant -0.16 -0.48 – 0.21 0.024 0.3882* publications prior to appointment vs. total years of appointment No. of consultant 0.62 0.35 – 0.80 0.39 0.0001* publications since appointment to consultancy Difference between PRP Regional 1.76 – 6.54 N/A 0.2365** for appointment to a hospital central vs. regional Central 3.91 – 7.19 consultancy hospital Difference between PRP Regional 2.76 – 8.78 N/A 0.1303** after appointment to a hospital central vs. regional Central 5.72 – 15.58 consultancy hospital * Spearman correlation. R-values given were appropriate, ** Two tailed Wilcoxon rank sum test. PRP – Peer

Reviewed Publication.

6 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Figure 1: Trainee publications based on orthopaedic subspecialties (X – publication sub-specialty, Y –

Number of trainee publications)

Basic sciences

Foot and ankle

General orthopaedics

General surgery

Hand

Hip

infection

Knee

Oncology

7 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

Discussion

This study examines the rate and quality of publication amongst Trauma and Orthopaedic trainees in one UK deanery. As expected there is a statistically significant correlation between year of registrar training and absolute number of publications. This correlation was expected as part of progression in training as determined at each trainee’s ARCP (Annual Review of Competency Progression) is partially influenced by each trainee’s ability to objectively prove the publication of his or her research projects. The authors had expected an increase in the number of 1st named author publications as a trainee progressed through the programme, and had taken a more active role in each of their research projects. This was not the case and the explanation for this is unclear but likely to multifactorial.

A significant correlation between each registrar’s absolute number of publications and the mean senior author’s publication score and the number of collaborative publications was identified. Both these outcomes were anticipated and demonstrated the logical conclusions that trainees who engage in research projects, whilst sharing the burden of work with a collaborative colleague, and with a senior author with a proven record of publication are more likely to also achieve publication of their own research. Furthermore a significant correlation between the quality of registrar publication and the mean senior author publication score was established. This probably reflects the value of publishing with a senior author who has an effective knowledge of what each respective journal is likely to accept for publication.

These results although logical have to date not been established, and demonstrate that if a trainee intends on achieving the suggested threshold of one quality publication per year of training, then one should strongly consider establishing their senior author’s publication background prior to embarking on a research project. In addition to this, to further enhance the chances of gaining a publication, then working in collaboration with a fellow rotational registrar is likely to be beneficial. This may be because collaboration towards a common goal may reduce workload.

The absolute number of publications prior to consultancy did not show a statistically significant correlation over the consultant appointments spanning a 23-year period. Some consultants appeared to have achieved appointment despite no identifiable peer-reviewed publications. This finding was unexpected and may reflect that historically the importance of achieving publication was less significant, or indeed that these consultants had achieved publication in non peer-reviewed journals that were not identified by the

8 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

methodology used in this study. Clearly an appointment to consultancy is multifactorial so trainees should heed these findings, especially in light of the increasing number of post CCT surgeons without consultant appointments. Furthermore, a consultant appointment to either a peripheral or central post requires a similar publication record, and as such trainees should be wary of considering peripheral consultancy appointments based on their publication background to be a less academic appointment.

Conclusion

Trainees aiming to improve their probability of achieving a quality publication should engage in research projects with senior authors who have a proven publication record. Collaboration with a fellow registrar on the rotation is also likely to be helpful. As the mean number of publications required for consultant appointment is four, a threshold of one peer-reviewed publication per year of training is a useful benchmark but this is likely to increase as consultant appointment becomes more competitive with the surplus of post

CCT trainees currently seeking appointment.

Practice Points

1. Trainees aiming to improve their probability of achieving a quality publication should engage in

research projects with senior authors who have a proven publication record – as readily

identifiable on PubMed.

2. Research collaboration with a fellow trainee is likely to enhance your chances of achieving a

peer-reviewed publication.

9 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org Publish or Perish – How to avoid perishing? An analysis of factors affecting peer-reviewed publication

References

1. Benes V. The European Working Time Directive and the effects on training of surgical specialists

(doctors in training): a position paper of the surgical disciplines of the countries of the EU. Acta

Neurochir (Wien). 2006 Nov;148(11):1227-33.

2. Dawson J, Harrison E, Taylor I. Research in the training of general surgeons: results of a survey.

Ann R Coll Surg Engl 1996;78:188-91.

3. Elbadrawy M, Majoko F, Gasson J. Impact of Calman system and recent reforms on surgical

training in gynaecology. J Obstet Gynaecol 2008 Jul;28(5):474-7.

4. Evans CH. John Hunter and the origins of modern orthopaedic research. J Orthop Res

2007;25:556-60.

5. Fazel S, Ebmeier KP. Specialty choice in UK junior doctors. BMC Med Educ 2009(24);9:77.

6. George S, Moreira K. Publishing non-research papers as a trainee. Singapore Med J

2009;50(8):756-8.

7. Goddard AF, Newbery N. Survey of medical CCT holder’s career progression 2009-11. Royal

College of Physicians, June 2011. www.rcplondon.ac.uk/sites/default/files/survey-of-medical-cct-

holders-career-progression-2009-11.pdf.

8. Soyer P, Taourel P, Trillaud H, Vicaut E, Laurent F, Dion E. Why and how to write and publish a

paper in a radiology journal. J Radiol 2011;92(3):171-82.

9. The Royal College of Surgeons of England. The Surgical Workforce in the New NHS. London:

The Royal College of Surgeons of England; November

2001.http://www.rcseng.ac.uk/services/publications/publications/pdf/surg worknhs.pdf(cited

November 2004).

10 | P a g e Torrie P.A.G, Berstock J.R, Hayward E.B.S and Bannister G.C MedEdWorld Publish www.mededworld.org