During my PGY-4 year, I had the opportunity to pursue a specialization in Academic Scholarship.1 My year had two primary components: (1) I was the inaugural Editorial Intern at the Canadian Journal of Emergency Medicine,2 and; (2) I was the Digital Scholars Fellow at CanadiEM.3 Over the course of the year, I learned many lessons about publishing in academics. I wanted to share three of the most pertinent lessons with our community to encourage those pursuing academic projects.
1. Not all projects make it to publication
Growing up, my parents always emphasized that your character is defined not by how you start things, but how you finish them. In medicine, we are driven and occasionally stubborn in our pursuit of success. Starting a project and not finishing it feels foreign and a lot like failure. What we don’t talk about is how common this is in academia. Celebrated scholar Lara Varpio estimates that 50% of her projects never come to fruition, which she considers the cost of doing business.4
Other fields, like Design or Innovation, seem to understand this idea better and expect that most prototypes will never make it to production, but that the process of prototyping helps distill the best ideas and helps nurture the creative process.5 Over the course of my medical training, I have developed at least four projects to fairly advanced planning stages, before various factors have put a hold on them (e.g., suboptimal idea, lack of resources, lack of mentorship, competing interests on time). I know that many or all of these projects will never result in anything. It’s hard to admit “defeat” but coming to terms with it helps you move on and frees up time to pursue other projects or life goals.
2. Revise and resubmit is (almost) the best result from journals
Peer-review can feel like a ruthless, opaque process.6 I have become acquainted with the sinking feeling of seeing your hard work torn apart by peer-reviewers. You’ve put in so many hours into your manuscript, edited it countless times, and your reward is anonymous critiques that can sometimes feel biased, unfair, or straight-up rude. The revisions in “Revise and Resubmit” can be so extensive that it feels like you are starting from square one. I have spoken to many colleagues who hit this stage and want to give up. The good news is that Revise and Resubmit usually translates to genuine interest in a paper, and the vast majority of papers receiving that decision eventually get accepted.
Many journals have four general decisions for submissions:
- Revise and Accept (minor revisions only with a commitment to accept the paper).
- Revise and Resubmit (major revisions with no commitment to accept the paper).
In reality, the first two decisions are quite rare for an initial submission. So, realistically, there are only two decisions that an author can expect. From a Decision Editor’s perspective, if a paper has a fatal flaw, does not meet the niche or target readership of the journal, or repeats a similar recent publication, the decision should be reject.7 The majority of papers at most journals land in this category. On the other hand, if the Decision Editor feels like the paper is anything above rejection, there are multiple reasons why their decision will be Revise and Resubmit. For example, even if a paper is quite close to being accepted, a Decision Editor might feel that a Revise and Accept decision would lead to author complacency and a half-hearted revision, so Revise and Resubmit is a way of enforcing an honest effort.
Ultimately, I’ve learned that I am rewarded for pushing forward with the Revise and Resubmit decision. One of the goals of peer-review is to improve the quality of published work. In my experience, I have seen my work improve by leaps and bounds when I have the chance to reflect on the final product, even if my initial reaction was not always optimistic.
3. Finding and filling the gaps
I used to think that journals only published scientific studies. In fact, they publish a wide variety of article types, many of which do not require ethics approval or funding. Now that I am a senior resident, I frequently get asked by medical students and junior residents about how to get involved with scholarly work and how to get published.
One of the easiest ways is to take work one is already doing for medical school or residency requirements and turn them into publications. This concept has been called “Multiple Wins,”8 can be applied to traditional publications, and is an approach that I strongly endorse given the various time constraints we have. One great example is journal club. Many of us have to prepare critical appraisals for our local journal clubs. Yet, fewer know that many scientific journals publish this as a regular column and that it takes a relatively small amount of work to take that critical appraisal and submit it for journal publication.9 Recently, I co-wrote an editorial that outlines these types of opportunities at CJEM,10 and there are resources that guide residents in composing a wide variety of scholarship types.11–15 Other journals have other under-used opportunities that would befit a junior learner, such as the Residents’ Perspective section at Annals of Emergency Medicine, the “Five Things to Know About” section in the Canadian Medical Association Journal, or the Clinical Images section that can be found at many journals.
In summary, work in academia is a labor of love, and it takes perseverance to navigate the process. I hope to have shared some lessons that will encourage you to start or remain engaged within the community!