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8 Publishing in Academic Medicine: Does It Translate into a Successful Career?

Bradley K. Weiner 1, Paige Vargo 2, and Joseph Fernandez 3

1The Methodist Hospital Research Institute, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

2Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA

3Houston Methodist Hospital, Department of Surgery, Houston, TX, USA

8.1 Introduction

The “outcomes” movement in healthcare and the subsequent emergence of evidence‐based medicine over the past 30 years have been predicated upon a single question: Why are we doing what we're doing? It started as a general inquiry and evolved to include a more specific line of questioning. Why are we ordering this test? Does it provide the information we need to guide our therapies? Is it sensitive? Specific? Accurate? Have a good positive and negative predictive value? Beyond diagnostics, we began to further question our therapeutic approaches. Why are we treating this disease this way? What are the patients' real outcomes? Are there randomized trials to support what we are doing?

Thus, a shift has occurred in our approach to practicing medicine from doing what we have been taught by mentors (directly or via their textbooks) or what personal experience has taught us, to doing what we assess may provide the most desirable outcome. Surprisingly, a similar perspectival shift has not occurred inside the world of academic medicine, and specifically with regard to the publication of scientific articles. While there is plenty of literature available to support academic physicians on the nuts and bolts of getting their work published, very little addresses the philosophical question of why we do what we do. What are the motivations for our publishing in the medical scientific literature? And what are the potential outcomes?

In this chapter, we will explore why publishing our observations and findings is important and how the act of publishing can impact both our audience or community and our careers.

8.2 Dissemination of Knowledge and Impacting Patient Care

A key component of evidence‐based medicine is that the evidence itself is to be found primarily, if not exclusively, in medical literature. What physicians are taught by their mentors and what they experience during their practices, while important, are considered lesser forms of evidence informing the medical decision‐making process. The trump card of evidence‐based research is the published results of quality cohort studies, randomized trials, and systematic reviews.

One of the major reasons why we do what we do – why we write with the goal of publication – is to impact patient care. If the results of what one is publishing are to form the foundation for decision‐making by other physicians, whether locally, nationally, or around the world, then one is able to impact individual patients whom they have never met through their published writings. Therefore, publishing offers the tremendous opportunity – and at the same time the responsibility – to do good beyond the confines of personal location, time, and energy.

The philosopher Karl Popper (1978) described “world 3” as manmade ontological entities that take on a life of their own with the ability to impact the world for better or worse (Table 8.1); the characteristic of world 3 objects or entities is that they can be improved by criticism and they may stimulate people to think. Popper maintained that “My thesis was that world 3 objects such as theories play a tremendous role in changing our world 1 environment and that, because of their indirect causal influence upon material world 1 objects, we should regard world 3 objects as real.” A published, scientific article is one such entity. An article that is of high‐quality and high‐impact can change the world, even if it is a simple case series. For example, consider the impact of an article identifying the antibiotics for bacterial meningitis, or the first report of reverse transcriptase blockers for HIV. In fact, the ability to impact a population requires dissemination of knowledge in the form of publication. If one feels they can help people beyond their own limits, they should write. Even in the publishing world, it is a good reminder that altruism and obligation are inextricably tied.

Table 8.1 Karl Popper's pluralist concept of three interacting worlds or sub‐universes.

8.3 Becoming a Recognized Expert

While the vast majority of scientific publications may be thought of as research projects put onto paper – one‐and‐done documents of clinical observations or therapeutic recommendations – many truly motivated academicians think of a particular article they have authored as merely a chapter in an ongoing program. It is a mantra of our research institute and laboratories; long before the first experiment is conducted, before clinical research is gathered, the academic physician thinks of the program, as opposed to the project. A program, in this sense, is a pathway of investigation that may take many years to develop, with the end result being a direct and substantial impact on patient care.

Publication serves as a public document of the pathway undertaken; a story that can be read by others that establishes the authors as experts. The audience may include a very important constituency: those who control the flow of money to support promising medical initiatives, those who review and assign grants (federal, foundations, and the like), and those who will invest entrepreneurially (venture capitalists, pharmaceuticals, and device companies). As such, publication of medical and scientific literature has the secondary effect of providing the financial support for further research along the pathway, an absolute requirement if novel ideas or observations are going to be properly explored and elucidated to impact clinical practices and hence patients.

8.4 Academic Promotion

The act of publishing medical or scientific literature, to a point, serves as passage to academic promotion. There are only a few such opportunities for advancement available to those in academic medicine. Teaching is one means of promotion for the academic physician, but it can be hard to measure and even harder to observe, as teaching moments often happen within the clinic or operating room. Thus, while there may be superstar educators who might achieve promotion through teaching or service alone, the majority of academicians will ascend via publication. Grants are, of course, a valuable means to promotion, but as we outlined above, important grants are almost always predicated on a solid foundation of a publication pathway.

Notice that we did not say research but publication. It may be said that in the eyes of the ambitious academic world, research that does not lead to publication or patents did not happen. Presentations and abstracts are often not considered as reliable and effective as a published, peer‐reviewed article. Thus, the most achievable road to academic advancement is paved primarily by scholarly publication.

8.5 Professional Standing

Respect within a professional or academic community, nationally and internationally, for a physician is often defined by his or her publication record. Publishing quality articles in scientific journals most often requires sound methodology (academic or clinical) coupled with excellent writing skills. These two commonly underrated factors will allow the physician‐author to stand out amongst his or her peers. Consistently well‐written, well‐constructed content will garner the author respect at the local, national, and international level. Much comes with that, including professional advancement and recognition − being deemed an expert within the greater medical or research community.

8.6 Personal Satisfaction

There are, of course, some simpler pleasures associated with academic publication. The “byline” phenomenon means something on the local level, a source of pride for the academic department, institution, and so on. But it also means something closer to home. Speaking from the most personal level, we delight when our children or our friends – on their own – have searched us on Google Scholar or PubMed and shared their admiration of our accomplishments. In a romantic sense, publication is our legacy, both professional and personal.

8.7 Editorial Benefits

Just as lifting weights is a form of training that directly enhances physical athletic performance and reading great novels helps the novelist improve his own works, the act of publishing medical and scientific content allows one to significantly improve their reading and critical thinking skills. As a published author, the practice of being self‐critical when it comes to writing better prepares one to critically assess other scientific literature and to distinguish the “wheat from the chaff.” It also allows one to develop improved editorial skills, for example, as a reviewer or editor for a scientific journal, advising other authors on how to improve their writings. Without a developed critical eye and practiced editorial skills, many great scientific papers of the past might have failed to make the impact necessary to directly improve patient care and our community today. How it is written does matter, and those who write well can help others get there, too.

8.8 Professional Contacts

The publication of an article can often open the door to unexpected opportunities. Another researcher with similar interests contacts the author and collaboration is born. It may also lead to consultant positions in government or industry, or in a company or venture capitalist interest. A well‐written paper can be career‐, even life‐changing for the author as well as the audience. The professional networking potential presented by publication is not uncommon, and the impact of scholarly publication extends far beyond the confines of academics to all facets of society.

8.9 Summary: Does Publishing Scholarly Articles Translate into a Successful Scientific Career?

For many residents, young physicians, surgeons, and scientists, the answer to “why are we doing what we're doing?” as it pertains to publication is simply because it is what we do. It is just part of the game, in a sense. However, when we carefully reflect on the consequences of publication, we realize that it is not a game but rather, it is serious business. First, the author can directly impact patient care far beyond his or her local confines by enhancing the evidence‐base, which serves as a guide for the proper care of patients and development of new technologies. Second, a well written, well‐received paper can blossom from a one‐and‐done project to a flourishing program. Third, publications can serve as a foundation for academic promotion, enhanced professional standing, and personal satisfaction. Fourth, by writing one becomes a better reader and critical thinker. And fifth, important publications can create a network of professional contacts leading the author down new, often unanticipated paths, with unexpected and extra‐academic implications. Therefore, it is without doubt that academic writing and publishing can directly translate into a successful career. Young physicians, surgeons, and scientists wishing to advance in their fields should be advised to ardently hone their writing skills in the greater pursuit of publication. Do it and do it well.

Reference

1 Popper K. Three Worlds–The Tanner Lecture on Human Values, Delivered at The University of Michigan April 7, 1978. Available at: http://tannerlectures.utah.edu.