Pub­lish and per­ish?

Mak­ing orig­i­nal re­search manda­tory in med­i­cal in­sti­tu­tions with­out build­ing re­search in­fras­truc­ture is un­re­al­is­tic

The Hindu - - OPED - Ge­orge Thomas & Prathap Tharyan

In June 2017, the Med­i­cal Coun­cil of In­dia (MCI) made pub­lish­ing orig­i­nal re­search in in­dexed jour­nals a pre­req­ui­site for ap­point­ments and pro­mo­tions of teach­ing fac­ulty in med­i­cal col­leges. Re­cruit­ment, ten­ure and pro­mo­tions are of­ten linked to re­search pub­li­ca­tions in the de­vel­oped world but mak­ing this manda­tory in In­dia is a bad idea.

Re­search ad­vances sci­en­tific knowl­edge and saves lives. The pres­sure to pub­lish mo­ti­vates clin­i­cians in aca­demic in­sti­tu­tions to pri­ori­tise re­search over other pro­fes­sional roles. Re­search pro­duc­tiv­ity en­hances careers and con­fers sci­en­tific recog­ni­tion and pres­tige. It pro­vides sci­en­tific cap­i­tal to in­sti­tu­tions and re­in­forces the pres­sure on fac­ulty to pub­lish or per­ish.

The con­se­quences

Many com­men­ta­tors have noted that the em­pha­sis on quan­tity over qual­ity has led to a flood of poor qual­ity re­search. In 2005, John Ioan­ni­dis in PLoS Med stated that most re­search find­ings could be proven to be false. In a 2009 re­port in The Lancet, Iain Chalmers and Paul Glasziou es­ti­mated that around 85% of re­search fund­ing was be­ing wasted across the en­tire spec­trum of biomed­i­cal re­search. They found that most re­search pub­li­ca­tions nei­ther ad­vance sci­en­tific knowl­edge nor have prac­ti­cal clin­i­cal ap­pli­ca­tions.

Re­search eats into the time that fac­ulty have for clin­i­cal care, teach­ing and men­tor­ing stu­dents. This de­prives stu­dents and pa­tients of the ex­pe­ri­ence of se­nior fac­ulty. It also con­trib­utes to stress and burnout in those left to deal with heavy teach­ing and clin­i­cal work­load. The dis­pro­por­tion­ate em­pha­sis on pub­li­ca­tions to de­fine suc­cess in aca­demic medicine in­flu­ences the cul­ture of med­i­cal ed­u­ca­tion, and the as­pi­ra­tions of stu­dents grad­u­at­ing from such in­sti­tu­tions. In a re­cent edi­to­rial in the In­dian Jour­nal

of Med­i­cal Ethics, Su­nita Ban­de­war and oth­ers es­ti­mate that med­i­cal col­lege teach­ers in In­dia, though lack­ing fund­ing, in­fras­truc­ture or pro­tected time, will pro­duce around 15,000 pa­pers a year if they fol­low MCI re­quire­ments. This is a field in which fab­ri­ca­tion, fal­si­fi­ca­tion, pla­gia­rism and mis­rep­re­sen­ta­tion will thrive. The nu­mer­ous “preda­tory” jour­nals that In­dia hosts will pub­lish them for a fee and flour­ish, while health care and aca­demic in­tegrity per­ish.

The mis­sion state­ment of the Na­tional Med­i­cal Com­mis­sion Bill, 2017, is “to pro­vide for a med­i­cal ed­u­ca­tion sys­tem that en­sures avail­abil­ity of ad­e­quate and high qual­ity med­i­cal pro­fes­sion­als; that en­cour­ages med­i­cal pro­fes­sion­als to adopt lat­est med­i­cal re­search in their work and to con­trib­ute to re­search”. What is lack­ing is a clearly ar­tic­u­lated vi­sion of the goals of med­i­cal ed­u­ca­tion and the role of re­search in the con­text of the chal­lenges and needs in In­dia.

The pur­pose of med­i­cal ed­u­ca­tion An­nals of In­ter­nal Medicine

A 2010 study in the en­vi­sioned the ba­sic pur­pose of med­i­cal ed­u­ca­tion as car­ing for the na­tional pop­u­la­tion, chiefly in pri­mary care and in un­der­served ar­eas. It ranked med­i­cal schools in the U.S. ac­cord­ing to a so­cial mis­sion score wherein Stan­ford (19) and Johns Hop­kins (20) ranked among the bot­tom 20 uni­ver­si­ties. As In­dia con­tin­ues “up­grad­ing” district hos­pi­tals to med­i­cal col­leges, and recog­nis­ing for-profit pri­vate med­i­cal col­leges, the NMC should re­flect on whether this “aca­demic” des­ig­na­tion will de­tract from the so­cial mis­sion that med­i­cal ed­u­ca­tion should serve.

In many Euro­pean coun­tries, no­tably the U.K., post­grad­u­ates and con­sul­tants are not re­quired to con­duct re­search, in train­ing or for pro­mo­tions. They are tested on their abil­ity to in­ter­pret re­search pub­li­ca­tions crit­i­cally. This pro­motes best med­i­cal prac­tice and ev­i­dence-in­formed health care. The NMC should de­velop two streams of med­i­cal fac­ulty: a clin­i­cal cadre and a re­search cadre. The clin­i­cal cadre of con­sul­tants should be ap­praised on their clin­i­cal, teach­ing, and com­mu­ni­ca­tion skills; au­dits con­ducted to im­prove ser­vices; and con­tin­u­ing pro­fes­sional de­vel­op­ment cred­its. The re­search cadre should be ap­praised on the qual­ity, in­tegrity, sci­en­tific rigour and im­pact of their re­search; clin­i­cal col­lab­o­ra­tions; and teach­ing and guid­ing re­search. In or­der to in­crease the value of re­search in­vest­ments, the NMC should also adopt 17 in­valu­able re­search-based rec­om­men­da­tions on re­duc­ing the “waste in biomed­i­cal re­search”, sum­marised in a se­ries of pa­pers pub­lished in The Lancet in 2014.

Some aca­demic in­sti­tu­tions in In­dia do good re­search and this should be en­cour­aged. Mak­ing orig­i­nal re­search manda­tory now in other in­sti­tu­tions, with­out in­vest­ing in build­ing re­search in­fras­truc­ture and ca­pac­ity, is ill-con­ceived, pos­si­bly un­eth­i­cal and cer­tainly un­re­al­is­tic. Ge­orge Thomas is a con­sul­tant orthopaedic sur­geon at St. Is­abel’s Hos­pi­tal, Chen­nai. Prathap Tharyan is Ad­junct Pro­fes­sor, Clin­i­cal Epi­demi­ol­ogy Unit, Chris­tian Med­i­cal Col­lege, Vel­lore. Views are per­sonal

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