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.
| Composition | Example | |
| World 1 | Physical objects and entities | Nonliving physical and living, biological objects |
| World 2 | Mental or psychological entities | Thoughts, decisions, perceptions, and observations |
| World 3 | Objective knowledge (the products of the human mind) | Myths and scientific conjectures or theories |
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