Communication in Occupational and Environmental Medicine

Tee L. Guidotti OEMAC

2011

Master Communicator of His Age!Ramazzini set the bar

high.

He was known in his own time as:

An excellent prose stylist, writing in elegant Latin

A superb lecturer (one of the most popular at the University of Padua)

Able to converse with workers and aristocrats

Channels of Communication

FormalInformal

Journals Books Internet

Blogs Social

media

The take-home message of this presentation is that formal and informal communication styles in science are changing and to some degree converging.

This affects occupational and environmental medicine in mostly beneficial ways and opens opportunities.

These changes may make academic careers more difficult, however.

Important, but not what we are going to talk about today. This is a whole other talk!

Journal Publishing

The rise of CMAJ to a world-class, high-impact journal is one of the great success stories of medical publishing.

How did we communicate knowledge about science before the modern journal? In the earliest days,

By letter, which became: Journals The modern “original research

paper” By books, which became:

Monographs Encyclopedias The modern “review article”

Then came journals Then came the internet

Electronic publishing is recreating letters

Relational, nonhierarchical searches (the ideal) are “recreating” manuscripts or at least their function

Medical Journals

Earliest scientific journals often carried medical articles (e.g. Philosophical Transactions)

Earliest medical journals followed same model as general science: Journal de médecine (1683) Medicine Curiosa (1684)

Oldest surviving: Lancet (1823) Boston Medical and Surgical J NEJM

(1828) Provincial M&S J BMJ (1840) Annales de chirurgie (1849)

Occupational Medicine

Oldest Most Influential Today

Medicina de Lavoro (Italy, 1901)

Archives of Environmental and Occupational Health (US, 1919)

Archives des Maladies Professionnelles de Médecine du Travail et de Securité Sociale (1946)

There has never been a regular journal of OEM in Canada. Nearest was Occupational

Health in Ontario

Scandinavian Journal of Work, Environment and Health

Occupational and Environmental Medicine (the blue journal)

Journal of OEM (ACOEM)

Occupational Medicine (the yellow journal)

The Canadian Journal of Occupational Medicine It never happened. In 1988, OEMAC commissioned a feasibility

study. Potential market was too small MRC unlikely to subsidize (this was before CIHR). Cost much too great for OEMAC to subsidize. Limited pool of reviewers and authors who were

not already committed to an established journal Reviewed journal alternatives

Identified Occupational Medicine (yellow journal) as best fit.

Negotiations foundered on language policy. Rest is history, sort of.

Occupational Medicine Medical journals in general have lower impact factors than

in other scientific fields. Most readers are practice-based, not scientists; don’t write

papers Basic sciences are cited by both but basic scientists rarely cite

practice journals. Dominated by a few highly cited journals, everything else drops

off quickly by specialty (except cardiology) Occupational medicine journals do not do well in direct

comparisons with other scientific and medical journals. Field is small. Authors in OEM do not cite one another as often. Much OEM-relevant material is published in journals out of the

field. Content of original research is less than other medical

specialties, but still much higher than in OHS/HSE sister fields.

The Journal Publishing Process (Then)

Work performed, paper then written Selection of a journal (first choice) Submission Peer review process

Editor selects reviewers Reviewer’s comments are returned to Editor

Decision made, informed by reviewer’s comments If accepted, paper goes into queue for publication If accepted subject to minor revisions If returned, invitation to resubmit after major revisions If rejected, author may repeat with another journal or drop it

Galley proofs sent to author for revision Published in print

The Journal Publishing Process (Now)

Paper is written as work is performed Journal usually in mind already (first choice) Submission is electronic Peer review process

Editor selects reviewers, authors may propose Reviewer’s comments are returned to Editor

Decision made If accepted, paper goes into queue for posting electronically, enters

another queue for “final” publication in print If accepted subject to minor revisions, turn-around time can be quick If returned subject, invitation to resubmit after major revisions, but

essentially treated as a new submission If rejected, author may benefit from reviewers’ comments

Galley proofs sent to author on-line for revision Publication in print can follow e-publication by months

What Has Changed

Journals are usually published by large commercial publishers or sponsored by organizations or both.

Costs and time to publication have dropped considerably Electronic publishing and internet access Automated editing and communication (Apple world) Burden of copyreading/proofreading has shifted to

author Digitization of figures and photographs Printing costs are less

Access has shifted to on-line Purchase v. license v. open access Author/sponsor subsidizes publishing

Distribution of Journals Few high-volume distribution journals with

individual subscriptions (CMAJ, NEJM, JAMA, Lancet, BMJ)

Migration to on-line access (le Quotidien du Médecin)

Most journals have low circulation potential. Subscription base is libraries and institutions Bundled into package deals (hundreds) Publishers sell access, not physical copies Long “tail” to sales because of archival value

On-line publishing is changing everything. Increased archival value of back issues Language “communities” shifting to internet

Implications

Publisher Driven “Community”-driven

Cost-shifting from publisher to Editor and author, with no loss in quality

Massive savings on in-house editorial services

Replace printing costs with on-line journals

Premium titles: highest impact, not highest circulation

New titles easy to initiate Favors editorial quality,

content, timeliness Copyright protection

Trend for journals to become the centre of a particular scientific or medical community: Authors and readers are usually

the same people Internet groups and other social

media Language-centred communities

Problems finding qualified reviewers

Highly responsive to new developments

Copyright release and licenseCopyright

Impact Factors and Other Metrics Uses comprehensive databases:

Web of Knowledge (Thompson-Reuters, 7300 STEM and 2200 soc sci journals) “Impact factor” (for journals) “Eigenfactor” (weighted scores for individual papers)

Scopus (Elsevier, 18,000 total) Google Scholar

Impact factor is currently the standard for journals Reflects how often all papers in the journal are cited by

original articles in the other journals in the T-R database (proprietary)

“h” index A productivity indicator, taking into account quantity

published and frequency of citation Increasingly used to evaluate individual investigators!

Journals are coming to resemble social media! Postings to an on-line platform for a community of

reader/authors who offer comments and interact on-line

Reviewing is a little bit like comment + “Like” Next step is relational database and lateral search

strategies Context is everything, not the isolated fact

Context of the finding, the insight, or the proposition of the paper

Context of the application Context of the integration into knowledge This is especially true for OEM!

Careers will be evaluated on impact factor, h

Conclusion Needs in OEM “community” different

Need for high quality scientific studies Even greater need for integrative frameworks, discussion

Scientific publishing is coming full circle Social media is serving the “epistolary” function of

scientific “letters” Relational databases will soon serve the “integrative”

function of old manuscripts Community of readers and authors

Social media will recreate the role of scientific society Science blogs will be the equivalent of open discussions

at meetings, digesting and extracting information from content

Language-specific “communities” are a new opportunity.

Books

Book Publishing Books may be initiated:

By author, with prospectus By publisher, as for a series By a sponsor, that assumes risk and

cost Producing a book

1. Research the publisher2. Identify the editor3. Prepare a proposal4. Elaborate in a prospectus5. Book production is a contractual

responsibility of the author, editor6. Copyreading7. Proofreading8. Cooperation in marketing research

and promotion

Types of BooksTextbooksTrade publicationsPocketbooks,

“handbooks”, and manuals

HandbücherMonographsBelow, Handbuch der Physiolgie

Book publishing has changed.

Commercial Self-Publishing

Concentrated industry ROI, not volume of sales Overhead costs reduced

Fewer editorial services Less direct marketing Smaller inventories

Authors bear more of cost: Figures and indexing Copyediting Promotion Risk

Authors make little money on medical books today.

Self-publishing (e.g. Amazon) growing

Reasonable alternative for small fields

Control over design, format, promotion

On-line promotion and access are critical

On-demand printing Costs of distribution and

marketing Prediction: E-publishing will

replace self-published books.

Internet Publishing Pioneer in medical e-publishing was

eMed. Advantages:

Universal access Hyperlinks, lateral searches very easy Rapid updating possible Cheap cheap cheap Journal formats work well. Multimedia if desired Can integrate with social media

Disadvantages Book formats not so much (harder to read) Peer review casual “Like”! Web rot over time Competition for credibility

Why are graphics about internet publishing always so anachronistic?

Informal Communication Conferences and meetings have

played an essential role in keeping OEM together because of informal content.

OEM List: Occ-Env-Med-L@listserv.unc.edu

Blogs “The Pump Handle”

Social media Few sites specific to OEM, OHS, HSE Still learning how to use it in medicine Goes beyond information

dissemination Collaboration (ResearchGate) Discussion Shared resources Job opportunities Chat (an underappreciated function)

OEM-Relevant Sites I Follow on LinkedIn

Canadian Occupational Safety

Environmental and Occupational Epidemiology

Occupational and Environmental Medicine

Occupational Health and Safety

Occupational Health Network

Occupational Health Physicians in the UK

Occupational Health and Safety Professionals

OH-World

Oil and Gas HSE Professionals

OSHA Discussion & Support

RSM Occupational Medicine Section

Conclusion Scientific publishing is coming full circle

Social media is serving the “epistolary” function of scientific “letters”.

Relational databases will soon serve the “integrative” function of old manuscripts.

Community of readers and authors Social media will recreate the role of scientific society. Science blogs will be the equivalent of open

discussions at meetings, digesting and extracting information from content.

Communities need a place for informal discussion of OEM, not just access to scientific information.

Social media for Canadian OEM?