BMJ  2006;333:207 (22 July), doi:10.1136/bmj.333.7560.207

reviews

Personal view

"Call for papers"

"So have you got anything published yet?" This question greets me during each six monthly basic surgical training review, and the answer is always sadly predictable. This is my fourth such review and I look glum as I utter the inevitable "no" to this question. We are led to believe that the holy grail of published research will cease to be the golden ticket to attaining higher training positions when the Modernising Medical Careers (MMC) reforms are introduced in August 2007. One of the main benefits of these reforms will be the end of the mandatory wasting of months or even years of medical careers in order to publish something worthy enough to attain a training number; and if this is true then I, for one, will certainly be in agreement.

I remember being told as a final year medical student that "audit is the key to publication," and diligently spent hundreds of hours auditing the most mundane things to this end, but to no avail. It took me about three years of audit to realise the simple truth that anything that can be audited by an individual or a small group of people is, almost by definition, unpublishable, unless you happen to be extremely lucky in your subject or a journal is set up catering for people with a keen interest in all mundane things medical.

How could any journal refuse such gems of medical wisdom?

So I turned to the humble case report. I could see interesting cases all around me, but which ones should I write up? With the guidance of my consultant, I and a colleague wrote up the best two cases of my six-month urology job. We beamed with pride at the finished products. We felt invincible; how could any journal refuse such gems of medical wisdom?

We soon found plenty of journals willing to do just that. It was frustrating being told within days of completing the complicated online submission procedure that the case reports may possibly be best suited for another, presumably less worthy, journal. In this manner, many hours of NHS time were laboriously spent submitting the same reports to different journals and waiting for the rejections.

In despair, I turned to my current consultant and asked if he knew of anything at all that I could publish. To his credit, he pondered the matter and came up with an interesting idea concerning temperature measurement on the cardiothoracic intensive therapy unit, but my spirits fell once more when I saw the proposed start date of the study. After the ethical approval and the mandatory 56 page form had been completed, it was well after I would have left the post. Nobody I spoke to could come up with short, sweet studies ideal for the aspiring young surgeon.

Refusing to be beaten, I tried to be less pessimistic. Suddenly, I could see publishable studies everywhere. Like a mirage appearing across the main bay of the cardiothoracic ward, I saw an alcohol hand gel bottle, and resolved to thoroughly audit the use of such devices in the ward. Another mirage appeared in the form of the patient care pathway; I mused about how this pathway compared with others used elsewhere and could feel a review article formulating somewhere deep inside. On the way out of the ward one day, I happened upon the holy water font outside the hospital chapel and noticed the thin brown layer of scale on the inside of the dish. For the next few days, I considered a detailed plan concerning the microbiological study of holy water in all hospital chapels in the West Midlands; nay, the whole country. My excitement was short lived however, and I soon settled back into the usual routine of checking my email account for news of any progress concerning my two wretched case studies.

Research is something that we are constantly told is an absolute requirement to allow career progression, but the tide is thankfully turning. I have certainly found out the hard way how difficult it is to get an article published and I have deep, and growing, respect for those who succeed. However, I was reminded at my recent basic surgical training review of the importance of any publication at all, and, after a short period of denial, I once again set my mind firmly on finding something—something that I could publish, no matter how trivial, bearing my name. With this in mind, I made an appointment to see an anaesthetist with a reputation for good ideas. He pondered my question thoughtfully before leaning back in his chair and asking: "Have you considered publishing an audit?"

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New Cross Hospital, Wolverhampton gwynsamuelwilliams{at}hotmail.com

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