Publish and perish?

Publish and perish?

Context

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

What has happened?

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

The Consequences

• Research eats into the time that faculty have for clinical care, teaching and mentoring student
• 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.

The purpose of medical education

• A  2010 study in the Annals of Internal Medicine envisioned the basic purpose of medical education as caring for the national population, chiefly in primary care and in underserved areas
• 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.

What NMC should include?

• Two cadres: Research and Clinical: The NMC should develop two streams of medical faculty: a clinical cadre and a research cadre
  • Clinical 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 

• Research Cadre
  • The research cadre should be appraised on the quality, integrity, scientific rigor and impact of their research; clinical collaborations; and teaching and guiding research
• Reducing waste in bio-medical 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”, summarized in a series of papers published in The Lancet in 2014 

Conclusion

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.