From Research to Practice: Which Research Strategy Contributes More to Clinical Excellence? Comparing High-Volume versus High-Quality Biomedical Research

Which Contributes to Clinical Performance: Academic Output or Person–Environment Fit?

Background

The measures put in place by health authorities to ensure the professionalism of doctors are important. Hospitals in China have included academic outputs in the promotion criteria to incentive medical clinicians to engage in scientific research so that to improve job performance (JP). However, such practice disproportionally focuses on academic outputs but ignores the force of needs fulfilled brought by intrinsic incentive. This study aims to discuss the realistic problem regarding the promotion mechanism and the potential drivers to clinical JP.

Methods

This study was based on multi-source data collection on clinical performance from electric medical record (EMR), person-environment (P–E) fit from the survey, and academic output from personnel files of ward clinicians (n = 244) of general public hospitals who sought for career progression in Shanghai in 2020. Independent-Sample t-test and chi-square test were used for comparison of two sample means or constituent ratio between promoted and not promoted clinicians. Linear multilevel regression was conducted to examine the relationship between clinical performance and academic outputs and P–E fit.

Results

Clinicians who were promoted were more productive in producing academic outputs than those who were not (t = −5.075, p < 0.001). However, there was no difference in clinical performance between the two groups (t = −1.728 to 0.167, p > 0.05). The regression showed that academic outputs were not related to clinical performance, while higher P–E fit was associated with the improvement of various clinical performances.

Conclusion

This study shows that P–E fit plays a more important role in facilitating clinical performance than academic performance and highlights the importance of intrinsic motivation of clinicians in achieving clinical performance.

Does Success Breed Success? A Study on the Correlation between Impact Factor and Quantity in Chinese Academic Journals

Purpose

This paper studies the relationship between the impact factor (IF) and the number of journal papers in Chinese publishing system.

Design/methodology/approach

The method proposed by Huang (2016) is used whereas to analysis the data of Chinese journals in this study.

Findings

Based on the analysis, we find the following. (1) The average impact factor (AIF) of journals in all disciplines maintained a growth trend from 2007 to 2017. Whether before or after removing outlier journals that may garner publication fees, the IF and its growth rate for most social sciences disciplines are larger than those of most natural sciences disciplines, and the number of journal papers on social sciences disciplines decreased while that of natural sciences disciplines increased from 2007 to 2017. (2) The removal of outlier journals has a greater impact on the relationship between the IF and the number of journal papers in some disciplines such as Geosciences because there may be journals that publish many papers to garner publication fees. (3) The success-breeds-success (SBS) principle is applicable in Chinese journals on natural sciences disciplines but not in Chinese journals on social sciences disciplines, and the relationship is the reverse of the SBS principle in Economics and Education & Educational Research. (4) Based on interviews and surveys, the difference in the relationship between the IF and the number of journal papers for Chinese natural sciences disciplines and Chinese social sciences disciplines may be due to the influence of the international publishing system. Chinese natural sciences journals are losing their academic power while Chinese social sciences journals that are less influenced by the international publishing system are in fierce competition.

Research limitation

More implications could be found if long-term tracking and comparing the international publishing system with Chinese publishing system are taken.

Practical implications

It is suggested that researchers from different countries study natural science and social sciences journals in their languages and observe the influence of the international publishing system.

Originality/value

This paper presents an overview of the relationship between IF and the number of journal papers in Chinese publishing system from 2007 to 2017, provides insights into the relationship in different disciplines in Chinese publishing system, and points out the similarities and differences between Chinese publishing system and international publishing system.

Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative

PURPOSE

To define and develop a model of excellence for the clinical management of diabetic macular edema (DME) patients in a real-world setting.

METHODS

A multidisciplinary joint commission (5 ophthalmologists, 1 nurse, and 1 pharmaceutic) established a series of preliminary recommendations based on clinical guidelines and DME activity results from 8 Pilot Hospitals (PH). These were validated by members of each PH and a group of DME patients in discussion workshops. Thus, the validated guideline (VG) took into consideration different aspects, namely, main core points (ranging 0-100), criteria, and indicators. Finally, each PH own setting was compared to the VG in order to settle down a starting point to clinical excellence.

RESULTS

Mean PH score was 51.5 (range 30-65). As compared to their maximum, main points that showed best scores were Clinical Guidelines and Protocols (78%) and Portfolio of Services (73%). Topics reaching close to 50% scoring included Resources (55%), Innovation (54%), Care Process (53%), Organization (52%), and Leadership (50%). Lowest scores were observed in the Strategic Alliances (46%) and Staff (37%) points.

CONCLUSIONS

Analysis of each PH by the VG delivered a global vision of the starting situation, especially focused in the identification of the different improvement areas. In order to further extend this model into the Public Health System, the effect of implementing it in different hospitals should be assessed to analyze its impact on daily clinical practice and health economics.

An Empirical Investigation of "Physician Congestion" in U.S. University Hospitals

We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures of clinical scores, as well as a rich set of covariates, we found that the relationship was indeed hump-shaped. At the two extremes, departments with an insufficient (excessive) number of physicians may gain a substantial increase in healthcare quality by the addition (dismissal) of a single physician. The marginal elasticity of healthcare quality with respect to the number of physicians, although positive and significant, was much smaller than the marginal contribution of other factors. Moreover, research quality conducted at the ward level was shown to be an important moderator. Our results suggest that studying the relationship between the number of physicians per bed and the quality of healthcare at an aggregate level may lead to bias. Framing the problem at the ward-level may facilitate a better allocation of physicians.

Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms

BACKGROUND

Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon's research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon's academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms.

METHODS

We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates.

RESULTS

Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes.

CONCLUSION

Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes.

Publishing Venues for Education Scholarship: A Needs Assessment

OBJECTIVES

Education research is a developing field. It is unknown if there are adequate venues for scholarship distribution. The objectives of this study were to identify types of education scholarship produced, where this type of scholarship is published, barriers to achieving publication for education scholarship, and perceptions of adequacy of publication venues.

METHODS

Study participants were emergency medicine (EM) education and academic leaders who completed an online survey consisting of multiple-choice, completion, and 10-point Likert scale items.

RESULTS

A total of 45 of 59 (76.3%) subjects completed the survey. A total of 33 of 45 (73.3%) respondents had published education scholarship. Most (29/44, 65.9%) felt that there were inadequate venues for publishing education scholarship. Of those who publish education scholarship, most (30/33; 90.9%) publish either less than one or one to two peer-reviewed products per year, but collaborate with others more frequently (less than one per year, 7/33, 21.2%; one or two per year, 17/33, 51.5%; three or four per year, 7/33, 21.2%; five or more per year, 2/33, 6.1%). The most frequently published scholarship were curricular innovations and original research, with mean ratings of 5.61 and 5.21, respectively, on a 10-point Likert scale. Peer-reviewed print journal was the most frequently utilized venue, with a mean rating of 6.21. Other venues (mean rating) include peer-reviewed online journal (4.0), MedEd Portal (3.58), free open-access education (3.47), newsletter (3.0), and curricular toolbox (2.55). The most common rejection reason was "not suitable for this journal/venue," with a mean rating of 5.33. Other reasons include research methodology (4.07), small sample size (4.17), single-site study (4.28), and misunderstanding of project purpose (4.10). Respondents believed that additional education supplements in journals would be most helpful in increasing successful publication, with a mean rating of 8.31. Other helpful items included a central online repository of venues that publish education scholarship, online training in education research design/methodology, and an online networking site of education researchers to promote collaboration, with mean ratings of 6.88, 6.75, and 6.28, respectively.

CONCLUSION

The majority of our sampling of EM education and academic leaders publish education scholarship. There is a perceived lack of venues for this work. Multiple barriers as well as potential strategies for success have been identified. This information may inform interventions to support the dissemination of education scholarship.