Health and bio-medical communities in Pakistan have come a long way in conducting and publishing research, both nationally and internationally. This is a testament to the efforts of premier medical governing bodies and professional medical associations in the country. These include Pakistan Medical and Dental Council (PMDC), College of Physician and Surgeons of Pakistan (CPSP), and Higher Education Commission (HEC). We at the Journal of Pakistan Medical Association (JPMA) have seen an exponential rise in the number of submissions over the past decade.1 This is also reflected by the number of manuscripts we at JPMA publish each month, and our acceptance rates over the decades. Based on an unpublished review of PakMediNet, the online searchable database of Pakistani medical journals in the country;2 this increasing trend has also been echoed at other Medline indexed and non-indexed medical journals in the country.
JPMA was started in 1953 and has been indexed in Index Medicus and PubMed since January 1975.3 It is one of the first and the oldest general medical journal published in Pakistan that has been indexed by the PubMed. In the January 1978 issue of JPMA, only four original articles were published and one editorial, with no short reports, short communications, or letters to editor.4 In January 2016, cumulatively 33 manuscripts were published,with 19 original articles, and 13 other types including editorial, short communication, case reports, letter to editors etc.5 Quality of medical and health research conducted and/or published in Pakistan was further recognized and rewarded by the PubMed, when it accepted one quarterly general medical journal i.e. Journal of Ayub Medical College (JAMC), in January 2001.6 And another monthly general medical journal i.e. Journal of College of Physicians and Surgeons of Pakistan (JCPSP) in January 2003.7
Together these three Pakistani Medline indexed medical journals cumulatively published one hundred and seven articles in their first issue of year 2016 i.e. January/January-March, 2016, with sixty-seven original articles.5,8,9 Another bi-monthly general medical journal 'Pakistan journal of Medical Sciences' (PJMS), albeit not indexed by PubMed nonetheless is listed in this database, and in the January-February, 2016; it cumulatively published fifty-six articles, with fifty as original articles.10
In 2011, PMDC revised, and circulated appointment and promotion criteria for teaching faculty members in the medical and dental institutes/colleges of Pakistan.11 Enunciating the number and type of publications required for promotion/appointment of teaching faculty members in the various clinical and non-clinical departments of medical and dental institutes in the country. No publication is required for either lecturer, instructor, demonstrator, registrar or even assistant professor. While for associate professor three research publications and for full professor only five research publications are required. Publications are defined by PMDC as an original article only! PMDC's decision to totally disregard any other type of published research contribution i.e. 'Short Report', 'Short Communication', 'Editorial' 'Review Article' or 'Research Letter' has resulted in a narrow focus on the part of faculty or aspiring faculty members to exclusively focus on original articles. Anything other than that is regrettably, deemed as either "waste of time and effort" or "pointless exercise"! Secondly, no distinction is made between original article published in Medline indexed versus non-indexed journals or the impact factor of the journal. More surprisingly, the authorship as first author versus co-authorship is not appreciated either.
The policy of exclusive focus on 'Original Article' is short-sighted and inimical to the promotion of research and scholarship in the country. Not every research endeavor or project warrants publication as an original article. Authors are loath to be advised by the JPMA reviewers or editorial board that their manuscript, albeit important in its own right as contributing to the understanding of disease determinants and/or distribution, and advancing understanding of disease/health behaviour etc. nonetheless does not elevate to the level of original article. Such advice almost always results in a long chain of email correspondence and in some instances persistent phone calls from authors pleading that "But I need it for my promotion, and only an original article would do!". Motivation for conducting research and submission to medical journals might vary, but perception of publishing an 'original-article-or-nothing' is hardly conducive to promoting research in the country. Often authors, when told that their manuscript would — by necessity merits further processing only if reformatted as short report or short communication — choose to withdraw their manuscript and ostensibly venture (shop around) out to other medical journals to have it published as an original article.
The varying degree of computerization of medical/patient records in the country — especially by large private sector hospitals — and use of Hospital Information Management Systems (HMIS) in the past few years has led to a rather disturbing trend in manuscript submissions. JPMA has received several manuscripts for original articles, based on review of past three to ten years of patient records; merely describing the socio-demographic, clinic-pathological characteristics, and or outcomes in admitted patients, ranging anywhere from 50 to 200 patients. These manuscripts often list four or more authors, with titles ranging from head of the department, to medical officers, and even medical students. Such manuscripts although important in their own right, are not of sufficient import to warrant publication as original articles.
Similarly, several case studies have been received, describing just one case, with five or six authors listed. Often with questionable justification for contribution of each listed author, sometimes described as "administered anaesthesia to the patient/case"; in few instances, even listing two authors whose sole contribution would be akin to having administered anaesthesia to the patient. In other instances, six authors would be listed with first and last being teaching hospital faculty members and four as medical students!
It is time to further encourage and promote research in the country by requiring publications for the appointment of assistant professors and even registrars/lectures; albeit not only original articles but other types of research publications as well. Internationally, the most prestigious general medical journals like Lancet, and BMJ do not publish manuscripts in the form of original articles only. Even the BMC group of journals publishes an entire general medical journal entitled 'BMC Research Notes' dedicated to publishing short reports only.12
Promoting ethical conduct of quality health research in the country would also require establishing national or provincial registries to grant approvals for the conduct and monitoring of Randomized Controlled Trials. The need for such regulatory body has been echoed previously.13,14
PMDC and HEC need to revisit their decision that only original articles merit consideration for appointment or promotion of teaching medical faculty and assign credit — albeit lower than the original article — to other types of research publications including short reports/communications, review articles, research letters, in addition to editorials. Secondly, with relative surfeit of medical journals and research publications in the country, PMDC and HEC need to assign academic weight not just based on type of article published but also the subject matter of the publication, and the role of author in a given publication. Mere review of hospital records over the course of certain number of years should not be construed at par with a well-designed, executed, analyzed and reported clinical trial or a case-control study. Hence, the scores assigned based on sheer number of publications i.e. quantity need to be balanced against the quality of research published. So as to promote meaningful and quality research that actually advances health and medical science in the country.Furthermore, PMDC and HEC have promulgated different set of regulations for appointments and promotions for faculty members. There is also a need to bring uniformity in the selection criteria for medical college/university faculty appointments. HEC, CPSP, and PMDC are well suited to collectively harmonize and improvise quality of published research in conjunction with various professional medical associations in the country.
1. Jawad F. Zaheer R. Journal of Pakistan Medical Association. Poster presented at World Association of Medical Editors (WAME) International Conference for Medical Editors. New Dehli, India: 01 - 04 October, 2015
2. Pakmedinet - Pakistan's largest medical information gateway. [online] [Cited 2016 August 11]. Available from: URL: http://www.pakmedinet.com
3. NLM Catalogue. JPMA. The Journal of the Pakistan Medical Association. [online] [Cited 2016 August 11]. Available from: URL: http://www.ncbi.nlm.nih.gov/nlmcatalog/7501162 .
4. JPMA Vol26, No: 1 January, 1976. [Title missing] http://www.jpma.org.pk/index.php?act=issue&issueid=451. (Accessed 11-08-2016).
5. Journal of Pakistan medical Association. Home Page. [online] [Cited 2016 August 11]. Available from: URL: http://www.jpma.org.pk/ index.php?act=issue&issueid=491.
6. NLM Catalogue. Journal of Ayub Medical College, Abbottabad: JAMC. [Title missing] http://www.ncbi.nlm.nih.gov/nlmcatalog/8910750. (Accessed 11-08-2016).
7. NLM Catalogue. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. http://www.ncbi.nlm.nih.gov/nlmcatalog/9606447. (Accessed 11-08-2016).
8. JAMC Vol28, No:1 January - March 2016. [Title missing] http://jamc.ayubmed.edu.pk/index.php/jamc/issue/view/5/showToc. (Accessed 11-08-2016).
9. JCPSP Vol26, No:1 January 2016. [Title missing] http://www.jcpsp.pk/index.php?cmd=current_issue&action=site_links. (Accessed 11-08-2016).
10. PJMS Vol32, No:1 January - February 2016. [Title missing] http://www.pjms.com.pk/index.php/pjms/issue/view/49. (Accessed 11-08-2016).
11. Regulations for the appointment of faculty professorial staff/examiners/ principals /deans/administrative staff in undergraduate & postgraduate medical & dental institutions of Pakistan 2011. [online] [Cited 2016 August 11]. Available from: URL: http://www.pakmed.net/college/pmdc/appoint.pdf.
12. BioMed Central - Short Report. [online] [Cited 2016 August 11]. Available from: URL: https://bmcresnotes.biomedcentral.com/submission-guidelines/preparing-your-manuscript/short-report.
13. Sherin A. Clinical trial registration: Can we establish national clinical trial registry for Pakistan? Editorial. Khyber Med Univ J 2012; 4: 37-8.
14. Jawad F. The race for publishing original biomedical research articles in Pakistan. J Pak Med Assoc. 2017; 67: 1-2.
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