Publishing papers is important for academic development in the field of family medicine;1 hence, there is an increasing emphasis on research training in postgraduate family medicine training.2,3 Most family medicine programs focus on the ‘process of research’ and require the resident to submit a thesis or research report for assessment, rather than a paper for a journal publication. A study involving 190 former family practice residents of The University of British Columbia, Canada, between 1990 and 1997 found that although 55% were interested in publishing papers about their research projects, only 7% managed to publish their work.4 However, a more recent study conducted at The University of Ottawa, Canada, found that only 11% of the family medicine residents intended to publish papers about their scholarly projects.5
Long-standing efforts to get family medicine residents to write papers for publication have not been successful. One reason for low research publication output is the lack of manuscript writing skills. The method of learning called ‘see one, do one, teach one’ might not be the best approach to facilitate family medicine residents to write their first manuscript for publication.
In this article, we, a group of family medicine faculty from different settings and regions in Southeast Asia and North America, provided a summary of the discussion we held via Zoom (Zoom Communications Inc, San Jose, CA, USA) and emails to identify the barriers for and brainstorm ideas to support family medicine residents to write their first manuscript for publication. Therefore, this article aims to: (i) provide an overview of the current challenges in publishing; and (ii) propose interventions to support family medicine residents to publish their manuscripts in academic journals.
Challenges in publishing
Family medicine residents often do not have the skills, time and interest in writing a manuscript for publication in an academic journal.5 Intrinsic (eg procrastination, perfectionism, insecurity) and extrinsic (eg clinical responsibility) personal conditions are recognised as important barriers to address.6 During the group discussion, we identified three themes that should be addressed: (1) importance of writing; (2) roles of family physicians in writing; and (3) training and education in writing. Each of them is further operationalised as questions, as shown in Box 1.
| Box 1. Themes raised in the discussion |
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Theme 1: The importance of writing
- Why do residents need to write?
- Why is writing important for family medicine residents and faculty?
- Is writing part of the communicator role?
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Theme 2: Roles of family physicians
- Should family physicians be public intellectuals?
- Are we training technicians (clinicians) or scholars?
- What is the role of writing for the family medicine academic?
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Theme 3: Training and education
- Who are capable of training residents for scientific publication, dissemination and communication?
- How can we implement the training in manuscript writing as part of the family medicine curriculum without overloading the curriculum?
- How do we communicate complex ideas to readers?
- What is the goal of the residency training program (eg how many residents are expected to be successful at publishing their work? What is the right ratio of residents who achieve publication?)
- How do we make writing valuable?
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Implementing strategies to support family medicine residents to publish
A systematic review on interventions to increase publication productivity in graduate medical education trainees found that no single intervention could significantly increase publication productivity;7 however, among the top 10 publishing programs, appointing a research director was an effective intervention to increase the quantity of publications.7 Other interventions, such as having protected time; incorporating research publication as a requirement into the curriculum; having access to a research mentor or research assistant; providing information technology support; and having research funding, were potential strategies to increase the number of papers published in academic journals. The results showed some positive effects of these strategies, but they were not statistically significant.7 This review emphasised the importance of leadership in research as an important facilitator at a macro level, and a single intervention to drive the research output in residency training is unlikely to be effective.7 Although there are a number of articles providing useful guidance on publishing, ranging from preparing a manuscript to dealing with publication processes,8–10 they are not tailored to the needs of residents who have competing clinical responsibilities and training requirements.
We propose some potential strategies to facilitate writing academic papers in family medicine residency based on the themes raised in the discussion (Table 1).
| Table 1. Potential strategies to facilitate writing academic papers in family medicine residency |
| Theme |
Strategy |
| 1. The importance of writing |
Research and publishing should be highlighted as a critical agenda to advance the discipline of family medicine |
| 2. Roles of family physicians |
Writing and dissemination of scholarly work should be prioritised and aligned with residents’ core competencies, which is to learn clinical skills, be a good doctor and contribute as a communicator and an advocate |
| 3. Training and education |
- Most recommendations focus on actions at the curriculum level to structure training programs that support their residents
- Training in scholarly writing should be part of the family medicine curriculum
- Each residency training program needs to have clear expectations about whether writing is optional or mandatory
- A support system is required for writing skill building, describing expectations and curricular elements
- Different types of writing that can have impacts such as reflections, editorials, case reports should be highlighted. In addition, dissemination beyond manuscript writing such using as new and other innovative methods (eg blogs) should be considered to improve residents’ writing skills
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Conclusion
Writing a manuscript for publication in academic journals can be a challenging task for family medicine residents. Emphasising the importance of writing and roles of family physicians is a way to encourage residents to start writing. Training in how to write academic papers is required to improve residents’ writing skills. At the residency training program level, a clear program requirement can help facilitate residents to write their first manuscript for publication.