Byline Medical Return to Work Form Made Easy

Byline medical return to work form

dr. Dre Strom came to visit us from Boston she is an associate professor finest at Harvard is the hospitalist at beth israel deaconess she is the editor-in-chief of medic portal thank you she's the editor-in-chief of meted portal and also serves on the editorial board of two different publications she has several leadership roles in faculty development including vice-chair of mentoring and department of medicine and also the director of the wrapkin fellowship of medical education so thank you so much dr. Hong for being here and you look forward to your talk can y'all hear me okay all right good good nodding excellent all those people over there nodding a lot I'm gonna need that a active interact interactivity later so thank you so much for sticking with me and those of you who have actually been here for all three sessions we'll have gotten everything I have to say about medical education the three areas of passion that I have one is about writing and the scholarship of writing the second is Career Development and the third is faculty development so I have purged all that I have to share with you by the end of this session so I have no relevant disclosures and all right all right quiz number one we're gonna start with some interactivity who has seen the musical Hamilton has it been not in this area yet okay it's about to come out it well it is very hard to get tickets as soon as you hear about it you should what is Hamilton the musical fundamentally about which is probably hard to say if you haven't seen it but maybe many of you have access to the soundtrack it's actually about writing and here's one of many many quotes in the musical Hamilton about writing and I won't be the whole thing but I wrote myself out of hell when my prayers to God were met with indifference I picked up a pen I wrote my own deliverance there are themes and phrases in many of the songs in the soundtrack that are about Hamilton writing and what he did with the power of writing there's for instance one quote that is around he wrote like there was no tomorrow and that would be what I think is really the theme for today now the second exercise that I have is one that is actually kinesthetic in nature what I'd love you to do is stand up they'll stand up great we're gonna have a physical warm-up here I want you to shake your hot body and your faces stretch out your faces cuz I'm going to ask for you to have we did a little bit of a free association game yesterday where we were brainstorming about catchy titles that might get your work published and now I want you to do the facial and physical expression of the words that I'm gonna show you on the screen so the first word just give me your first immediate reaction with your facial expression with your hands and gesturing to the following word to admit our shifts okay all right I gotta see a little bit more I see no hand movements here no rude gestures post-procedure admissions okay here are some of these things all right transitions of care okay gonna see Mohamed there does that and then writing that's the one I want writing some expressions for writing I see kind of a lot of ambivalence more okay shrugging and so forth good okay did you capture that we're trying to put it on Twitter so let's give it one more shot at a very visible facial expression or gesture for your reaction to the word writing okay thumbs-down my seed you have anything here okay thank you so much for humoring me you may sit down alright in a lot of audiences where I do a similar type of needs assessment most people hate this process and there are a lot of different reasons I would say to when as soon as writing enters the conversation I suddenly feel guilt and all of those unpleasant thoughts and so my objectives today the first one is I want to call out those behaviors and be barriers that make it so hard for us to think about publishing and about writing there are system-wide problems and there are individual ones that you're all struggling with me included the second thing is to sort of think about action orientation what are the strategies that can make the process of publishing and writing much more satisfying than it currently is and lastly a commitment to yourself and possibly to your institution about making writing a more important part of your career so I want to tell you first a story about my first publication it was called it was about residents being uncomfortable with doing inpatient procedures when I started writing this work and it was about 2006 I thought oh my goodness this is so duh of course residents are not comfortable doing inpatient procedures but we thought that we would actually you know measure this and look at the impact of supervision on their comfort what I learned through this first process was one that even though ideas that I thought were kind of duh had some value as a contribution to the literature cuz believe it or not no one had really written about how uncomfortable residents were doing procedures was just part of the culture that we would just do them and secondly what I learned and possibly more important than anything else was the value of a mentor this was the research mentor who essentially gave me the formula to writing a manuscript some of which I taught yesterday he told me what it makes makes a five-paragraph discussion and essentially in doing so gave me the keys to scholarship I think back on that mentor and that experience and it makes me think while he was really the one that opened the door for me the second thing he did was when I got that first revise and resubmit from the American Journal of Medicine I was demoralized it was so negative since then I've come to realize that peer review is really about critique it's not about affirmation but he said that behind that revise and resubmit is an invitation to be published and so he helped frame the crying into a positive spin now I've only a couple minutes into my talk and I've already told you a lie that was not actually my first publication my first actual publication I'm kind of embarrassed to share about so I decided as an enterprising medical student that one way to get my work published was to enter a literary contest of all things so the Journal of General Internal Medicine was having four trainees a literary contest where you could submit a narrative I have a sister who has Lucas and has suffered deeply with that disease she's been the subject of my personal statements from college to medical school to residency and so I thought I'd write about what it meant to be the sister and a caregiver to my sister and it was really hard to put on paper it was very heart-wrenching I thought it was pointed I thought I'd expressed what was most powerful in my experience as becoming a physician through that and I submitted it now also being an enterprising medical student there was a poem as part of that essay I hate poetry I was an English major but absolutely hate poetry I threw together something in 15 minutes and submitted the to because maybe one of those two would get accepted what was accepted was my poem so they rejected the narrative about my sister someone who has influenced me so strongly and continues to do so and what I learned about that experience with twofold is a rejection of something that was so personally compelling to me was not a rejection of my professional and/or personal identity but secondly and I'm not letting you read this poem there's a reason why it's such small fee I'm not giving you the citation either because it's a terrible poem but was around the idea of stepping out of your comfort zone I will never be known in scholarship as a poem poet but it was the it is the idea of like getting out of your comfort zone so so I now want to transition to thinking about together this unpleasant process and just uncovering it for all its the dirt that's underneath so part of the reason that it is unappealing to publish is that they're both systemic and then there are individual issues so I'm the systemic issues and I totally claim this because I'm an editor and I sit on a committee of other medical education journal editors one is the pressure to publish which how many of you feel yeah oh wow that's that's a lot of people dr. Han we all don't feel that pressure to publish is driving people to submit so manuscript submissions across the industry of journals are skyrocketing and as a result many editors have what is called a desk rejection a desk rejection is that it doesn't even go to peer review I've experienced this many many times from journals which it's just not worth really investing in peer review time if it's gonna be rejected anyway the second thing and this is a good thing is around the literature it's evolving we have moved out of their realm of pure descriptive studies to looking at some pre/post cohort studies and we have our CTS we even have systematic reviews on medical education literature and so the whole corpus of literature is evolving this makes it harder to publish a pre post study and that's just add nearly the case we've trained people better they're better psychometric tools there's a lot out there that enables people to do better research as especially in education and that's for sure true in the biomedical paradigm so those things are making it hard for any given person to publish the second issue is that our own identities I know you're living and breathing what I'm living and breathing which is that clinical footprint and the work is so overwhelming it takes me forever to recover from a weak being on service let alone two weeks or nights and so forth job descriptions vary multi-part I have a lot of administrative roles now and none of that has built-in scholarship time just the idea of protected time to do research when you're in education or in clinical innovation is just far and few between mentors are super busy and it's how you know when we put out calls to look for mentors we got plenty of mentee invitations but we don't have enough mentors to go around those people that want to mentor are overtaxed unfortunately by the need so those are some system issues I was talking to somebody about she had for some reason unearthed a college fa and she couldn't even recognize the person that had written that essay she couldn't believe how good it was if I had to kind of graph a trajectory and those of you with school-aged children if you've looked at homework lately I'm amazed that what my third grader is learning about essay writing and about you know compelling language and how to structure that I peeked essentially well sixth grade essay writing was very formative sophomore seminars in college there's a little blip here around spending months and months writing your personal statement only to realize that it takes residency directors like 10 seconds to read them and it's all downhill since then because this is what constitutes my writing is progress and discharge summaries so this is what you see essentially this is like telegraphic it's abbreviations it's deferring my writing somebody else's because the way the intern writes the HPI is much better than mine it's not even full sentences so this is really the majority and what I'm doing that constitutes writing so no wonder our skills have dropped so much what makes this challenging is as an educator this is everything that I'm putting out there and so when I submit it to a journal I get this instead rejection and the word and the concept of rejection is really nowhere else in academic medicine except in the parlance of journals right you don't get rejected from your job you know you transition from one place to another you don't so this this language is making it extra hard for us conceptually the other thing is just written into what it means to be a human being which is our love of numbers this is a quote from the little prince has anybody seen little prince one of my favorite things that I remember from sixth-grade is that grown-ups like numbers they don't ask questions like do you collect butterflies or what does this voice sound like they want to know how many brothers a person has will have how much a kid waive only then using those numbers do adults feel like they really know no and so when I talk to people about promotion these are the things that are being used to gauge what your worth is right you're in h-index the impact factor of the journals you're publishing this is by far and away the most common question asked when someone asks about promotion they flip to the very end of the institutional CV and they say how many things have you published right yes and what this has led to is what I call emotional albatrosses so every manuscript in draft starts with a struggle because the work of publishing or the work of even doing a project is a struggle and then whenever their struggle that leads to avoid them and then avoidance leads to guilt and this vicious cycle of terrible negative feelings results in shame this is what I'm seeing when people come into my office to talk about promotion and publication comes up as it always does what I see in their faces in these incredibly talented people their face is shame how many of you are struggling with the manuscript eternally in draft form I have a paper that's like eight years old in terms of the data and this is the elephant in the room essentially is the shame in academic medicine is around publishing so these represent some of our systems and individual barriers to publishing which is sad because it makes it hard to realize why do you want to publish and yes part of the reason why I want to publish is to feed my ego right I completed a project thank goodness I can get some closure on it a public statement of of what I've accomplished and of honor yes promotion it's impossible to separate publication from promotion and you know when you publish you are joining this membership this membership of self stuff prominent people were published I admit when something gets accepted I go quickly to my my Harvard catalyst profile is my online profile of publications and I go there and I stick my impressing that's all true but I think what I've learned over time is that it's also my gift to the community right I stay up at night worrying about problems for which I've got a couple of answers to and I've learned something along the way and my publications allow me to reach learners and faculty and administrative leaders beyond whom I can reach here in this room another thing that publications are for me is it's my voice and I would say as a small Asian female you looking younger than stated age my voice in person isn't that big but my voice in a paper is bigger and again it's around reaching people that I can't otherwise see and then they get to see beyond my my label and my hope is that you could see publications as this so how to get started I've talked about how bad and how hard it is and that all represents the barriers now I want to just give you the tools to figure out how to do it yourselves start with an idea and what is an idea this is something I would like to get published which is a typology of ideas it is either cause or effect so what would happen if we did this it is correlation how is this related to that or it's kind of the switching date we thought it was this but it was really that so these are I'm just saying this tongue-in-cheek that there are more ideas are a little bit deeper than this but these are the general categories I have ideas out there so let's take an idea and let's do some research so perform a literature review articulate a good question there are nine different study types we can design an intervention and we can conduct a power calculation beg for subjects pray for a mentor someone who will put their needs your needs over them realize you forgot to do an IRB go back and consent people collect data lose sleep altogether analyze the data or bribe or coerce a statistician sit down and write oh by the way you don't have any money to do this you don't have any time to do it either so that's what you could do with your great idea and implement it didn't research on the other hand you could take an idea and you can so this is a hierarchy of literature types and study designs and I find that's what's encouraging about education is that we're not in the realm where we're demanding RCTs we're kind of still in this realm of you know pre post studies and cohort studies that's not still not unusual in education and the second thing is that there's still value in editorials and letters perhaps in medical education more so than a lot of different realms in biomedicine I would be remiss if I didn't mention that an opportunity to publish what you're teaching is med ed portal the journal that is part of the double-a MC and what we really value is usability so a little bit about meta and portal MEDLINE index open access free no publication fee and that's I think what we're most proud of and the idea is anything that you're teaching or using to assess can be published in that at portal and that's peer reviewed right along with the manuscript the idea is that it's usable so you'd have to package it in a way that other people could use at other institutions but to move on you could take that idea and you could share it I already mentioned how perspectives and editorials have a lot of power still in academic medicine academics medicine not the journal but in general and so I just took a sampling of some of the prospective pieces that were published in the New England Journal recently and one is it's surfacing really important topics that we need to think about like sexual harassment and academic medicine but a subtext to that is these are not things that are too far off the realm of what you could write about right time's up for medicine only time will tell unfortunately some things that cut off there but like an angry patient these are not rocket science these are opinions stated by people just like you captured in a compelling way and published that happen to be published in the New England Journal if I had to give a very simplistic formula for what it takes to write a prospectus piece catchy title so how many of you are at that workshop title is everything yeah yeah nod not compelling tone and it helps to have a framework so let me give you an example of how I took lemons in my educational research and turned them into lemonade so flipped classroom done very well and a lot in undergraduate medical education we tried to do this in the internal medicine residency I had three really motivated residents who created Khan Academy type videos for teaching LVAD so left ventricular assist devices spend hours to do that they were popular - some of them were going to be chief residents and they convinced all their residents to do the videos before they attended the lecture on Elvis how many of their peers their friends do you think looked at the videos zero zero this is out of a class I know who I was really had yeah it's probably in your cohort to Keylong was a resident of ours so we don't blame her personally we got zero like spend all these hours putting together these materials and to work through the study design I PI for IRB create you know validity evidence around the assessment tools and nobody actually did the flipped classroom component of it so what we did is wrote a prospectus piece for the journal of general in a journal of Graduate Medical Education to say why the flipped classroom might not work in residency education and our compelling tone was there we had a catchy title and then our helpful framework was essentially why students might thrive in a flipped classroom environment and why residents who are working super hard get all their learning on the job might not benefit from flipped classroom so that's an example of taking you know a terrible outcome and at least putting my voice and our perspective out there in a way that's still cited you can take your idea and you can improve on it so really really reductionistic and simplistic but I think that the pipe biomedical paradigm for publishing focuses a lot on hypothesis testing and really accumulating proof that something's going to work this is incredibly important if you're going to make patient care decisions about this I think there's still more liberation around innovation in medical education and Qi as well so the burden of proof is less because in theory we're not going to harm the learners as much and so there's value in idea novel ideas and experimenting with that and figuring out how to scale it so this overly simplistic model works in the sense that we can publish a lot of innovation reports every Medical Education Journal has something that is a man trip type called innovation report and they all have different titles for that music but what it's essentially doing is surfacing innovation I'm just giving you an example some snapshots of journals that do this is the journal Graduate Medical Education and appearances teacher so that's kind of a play on residents as teachers here's another from the journal teaching and learning in medicine around residence reflections on non-medical home visits I hope and this is from academic medicine I hope you're thinking about your own work and the committees and the activities you're working on thinking I'm not that far off I have a great idea and I could report it as an innovation report and the great thing about this manuscript hype is novelty is what is prioritized over evaluation they're not looking for clinical outcomes to have change of these the focus is on how new is this as an idea I didn't list this here but one of my favorite innovation reports published in academic medicine and those of you who are administrative leaders might be amused to hear about this is actually about the use of simulation too and they had applicants for the department chair go through a simulation the simulation was a frustrated faculty member who wanted to get promoted despite not having published they put 29 applicants to the department chair position through the simulation and there's like no evaluation data but the process itself was so novel and their lessons learned from it were articulated very well in this so that's an extreme example of an innovation without any evaluation data that was put out into the literature you can take an idea and you can draw it I already learned from the last career development session that not all of us feel strong about artistic skills but this was drawn Eli do you know who did this yes absolutely I interviewed her for I interviewed Amita as an applicant to a residency program this is published in the annals of internal medicine and have a graphic medicine section this is work by grace Ferris who's a hospitalist that many of you may know who used to be at the IDM sea and is now at st. Luke's and she is a well she has carved an entire career around social media and her artistic skills this is coming from her role as a comic strip writer for the Dartmouth newsletter this is in Annals and it's about physician female physicians coming back from maternity leave back to work and I love this part box for your heart so what I love about where we've come so far in scholarship that we're only broadening the different types of manuscripts and publications I mean this comes with a citation in MEDLINE so there are different avenues for you to express and demonstrate your ideas it's no longer the original research manuscript you can still take that idea and design it so this is academic medicines last page my formula for it practical tips and some catchy infographic here's an example congratulations your article has been accepted now what media social media and other outlets for promoting your work for some of you you may be living and breathing that kind of practical tip and you could publish it in academic medicine as this I was working with a mentee who has a really neat way to think about slide 2 so every slide - for a clinical talk is around the epidemiology of delirium or you know that kind of very dry numeric data that most people sort of glaze over and he has just a neat way to present this in his talks on oncology topics he put it up as a infographic with some guidelines and then we just got this accepted in academic medicine so be on the lookout for that and then finally you can take an idea and you can narrate it so you are living and breathing amazing patient stories all the time find a way to take those clinical experiences and share it I'm running a writing group right now with about patient narratives and you wouldn't believe the stories that come out because your day-to-day interactions with patients have so much to contribute to the rest of us as physicians this is purposely in small font only to make the point that virtually every journal that has some clinical footprint publishes patient narratives and so when I think about oh one more thing take an idea and get somebody else to do it that's just a tongue-in-cheek way to say mentor somebody in it in academic medicine there are specific calls every summer I think we just closed the call looking for letters to the editor from trainees and only trainees can be on the byline this year's theme was on firsts and we just were oversubscribed with a number of trainees that wanted to submit their letters to the editor there's also JAMA internal medicines teachable moments first author must be a trainee so think about examples of waste that you're encountering day in and day out and think about working with a trainee who often have more energy and enthusiasm than we do to publish in JAMA internal medicine as a teachable moment so I think about the opportunities being ripe and so when you look at the access of word count from four hundred to three thousand we're beyond the original research three thousand word manuscript there's stuff all across the spectrum that where you can publish and when I think about word count 3,000 words is a lot I think it's like 15 double-spaced words but I could probably put together a six 600 word research brief research report for an educational journal new ideas Journal of general in Jeff canyons edge a GME has a call right now for new ideas they are looking for 650 word abstracts essentially of new ideas in Graduate Medical Education again those of you working in residency or education program leadership probably have great things that you could potentially submit and it's just easier to generate 600 words than it is 3,000 and then patient narratives really run the gamut here I mentioned 12 tips here which is a journal from medical teacher but the warning is that they're not actually accepting 12 tips anymore but 12 tips has been a very practical manuscript type for teaching things like how do I teach informed consent how do I teach the millennial learners things that you're living and breathing on our part of your daily life you could encapsulate into a practical tips type of manuscript just a word and I think this is one slide that I showed during my workshop around the different journals that you can publish in so these are the core medical education journals and there are many many more than this there's clinical journals that also publish medical education don't forget that medical education and Qi are essentially two sides of the same coin so think about these quality journal there are good educational research journals and there's also simulation so it really and this is far from an exhaustive list of journals where you can publish medical education type work if any of you are specialists then you can often take your educational innovations and try them out on your specialty journals you know for instance dermatology may not have it as many educators and so the work of that you would not normally be able to publish a medical education you could potentially take to your specialty journal okay I'm gonna switch back to the quiz mode what was the one thing that Atul Gawande recommended in the epilogue of his book better a surgeon's note on performance did anyone read this book yeah great book great book all right what do we think are you guys listening what is my talk on it's about writing so but here's the more elaborated quote on is an audience is a community the published word is a declaration of membership I already talked about membership choose your audience and write something he talks at the end of the book about ten things that you should do in writing is one of them all right so we have talked about why it's hard we are talking about different avenues for publishing that really go beyond the original research manuscript and now I want to think about writing in particular I think we're all big believers in the growth mindset except as it relates to writing because I hear a lot people say I'm a terrible writer I can't write I don't have time it's all very negative and so here is to encourage you to think about training and mentoring in writing specifically we could all benefit from training and mentoring to be better clinicians to be better educators but there are opportunities to ask somebody to be a mentor specifically for writing you may have seen your mentors on your projects ask them to give you feedback on their writing there's probably reason why they are your senior mentor and they may have a lot of facility with writing so ask about mentor mentoring your writing their writing groups I mentioned I don't know of how available they are in this institution I run them on specific manuscript types like patient narratives or perspectives pieces or innovation reports and so if that's an opportunity either through an organization or locally or you could start one that would be a great opportunity they're writing courses there are plenty of writing courses they're CME courses there's a master class that's offered utoronto and then there's self-study I have to admit that a lot of what I've learned about writing is meeting online let me advocate for a series in the journal perspectives in medical education by Lorelei lingard it's called the writer's craft and she essentially writes a series of articles about how to write the intro how to write the discussion what the methods are supposed to talk about those four articles will take you very far in the structure of the original manuscript I would say also one of the activities that has probably helped me the most as a writer is essentially peer review so it's so much easier to critique somebody else's work than it is my own and so watching some these unpolished work come in as a manuscript and helping them reframe it so that it becomes publishable helps me realize okay that's how that person should have spun that to make it more compelling or this is what disorganized methods look like much easier to do that with somebody else's work than your own there's also the idea of building a writing team and so to me the elements of a writing team involve a mentor again this there's a hidden curriculum here around the importance of mentorship the second thing is you know you need people that get it done I called them a worker bee but people who will push you and be that form of accountability in taking the next step you need a nitpicker this is the person who loves to copy edit and correct your grammar and punctuation and so forth I absolutely am one of those people and then sometimes your mentor serves this role but it can also be helpful to have a visionary someone who can write that fifth paragraph of the discussion section talk about the implications someone who has a broad-based view of the topic that you're publishing in so hopefully your mentor but not always maybe your mentor is really the person who's been guiding the project and this visionary could help you sort of get out of your head in terms of how you might pitch the work another important part of writing is becoming a student of writing so writing is an art you know obviously many people have the professions all based on it we don't we never got trained to be writers or to think about ourselves as writers and so there are many ways to become a student of the art of writing and one is the more you write the more you write it will get easier each time just as it is with any other skill the more you practice the more you drill the better you'll get and a corollary to that is the more you read the more you write I do not mean reading more charts or reading more patient notes but I mean collecting quotes this is the kind of stuff I had the liberty to do with it I was an English major was to collect quotes in the journal and to read with intention reading with intention whether it's scholarly paper or books is to say I love that word it loved that phrasing why was it that I was drawn to the way that was phrased and you will learn by kind of had of having a meta reflection on the reading process about how to use words to your benefit one thing about reading and writing is for me it's got a cadence it's so sometimes what I tell my mentees is this phrase just things because there's something about the pace or the tone or the word choice that makes it so especially persuasive and then lastly fall in love the English language I believe is really the only language I know but the English language is it's wonderful and it's beautiful sometimes readings not for you I find that NPR is a place that I can collect a lot of great words and I actually like a nerd I put those great words into you know a note note app on my phone so immerse yourself in language realize that you're already surrounded by great examples of writing whether it's in emails or newspapers or on the radio and this is my final point it's really the activation barrier this is probably the only concept from chemistry that I'm still retaining and we have this right you have reactants you have the skill set you have the motivation you have the goals and products are your scholarly products and what we have here is a huge activation barrier to me acknowledging that and figuring out concrete strategies to get over the activation barrier is step number one two and three I hope this talk has been around the idea of being crossing the threshold and these are the voices that are in your head that are stopping you these are the parts that are feeding into that activation barrier I can't do this I don't have time nobody's watching me do this it's scary to get rejected all of those things are fed into it so stop giving yourself excuses that's a hard ask but that is part of what's feeding into it so make it easy to take that transition from thought into word I talked in our career development session about the importance of taking unformed sort of vague thoughts and putting them into intention through the writing there's a neuro cognitive process that's really important in that construction so an ideas notebook it might be a physical one I mentioned that I have a Notes app and essentially any crazy idea that I get in the shower goes into my notes out it's very different from pulling out my logging onto my computer pulling up Microsoft Word trying to figure out where to save this document that has random stuff on it instead I just use a Notes app it might be the Apple Notes app with the app I use is called simple note and everything's in it like many many drafts of manuscripts that will never see the light of day but have a place where it's a natural reflex to take your ideas and put them in the form of words somewhere writing with reckless abandon is a nice way of saying vomit on the page and clean it up later this is a pract writing practice that I use all the time which is you know whether it's writing a letter of recommendation for a student or generating ideas for the intro is just to write write conversationally don't use synonyms don't hit the delete the Delete key just write and then clean it up later no one will see the first five or ten drafts of what you write and this allows you to liberate again to kind of get over that activation barrier it's related to the inner critic I think what I learned when I was an English major is like I had to choose the right word and I could never go back and edit it that's not definitely not the case anymore the concept of harnessing energy rather than time is a much bigger talk it comes from the business literature which is we all know we have very very finite time but your energy energy around an idea is something that can feed the motivation to write let me give you an example so I am working with some great hospice on this is like make it count twice we gave a workshop at SH M and this said into the idea of writing a perspectives piece we have great conversations on the phone we make them 45 minutes long and the 15 minutes for the rest of the hour is used separately for us to draft outlines for that manuscript I've just spent the time sort of engaging and thinking and getting excited about the topic why put that away and put it on a task list to have to come back to it three weeks later when I have no idea what we even talked about so harness the energy that comes from meetings or collaborative work to put something on paper and then lastly very mundane use dictation software last question so what did Paul Callan EP choose to do when he faced the terminal cancer diagnosis how many of you read one breath becomes air it's an unforgettable book and this quote is something that reminds me of the value and importance of writing I never met him he sounded like he was an amazing neurosurgeon but what I learned from him was his words be ready defeated he what courage sounds like above all see what it is to live to profoundly influence the lives of others by your words and that was his gift to us that has continued to live on even passes only so I hope I have given you a sense of that all the skills that you are bringing to this job into your life and things that you were naturally gifted with and the things that you could do can find some form of expression in scholarship no matter what it is that you do and I'm gonna end with a QR code so hold up your phone I just learned how to do this and your camera and pointed at that and magically a URL survey will pop up and the survey is essentially asking you to write down one thing that you will commit to doing differently as a result of this talk and if you want to get a reminder about it put your email address and Wow to email you with your three months your commitment in three months so did it work for anybody yes good I'm gonna give you a moment to think about what you're gonna put on there try to be specific and you know possibly measurable make sure you get that email address incorrectly great I'll let you continue to do that it has been a great pleasure sharing you what it's one of my passions I feel tremendous guilt because I now have to go back and actually work on publishing and writing myself thank you very much so thank again thank thank you grace for coming the rejection is often of a whether it be a grant or a a publication a significant barrier especially to young young individuals so could you comment a bit more about that and can you also comment a little bit more on the predatory journals and how to deal with predatory journals that are proliferating so those are two questions finally I did read a bit of your point it was great it looked like a hoe it would look like homeless a poem about a homeless person maybe it I didn't read it completely but it looked really good so you should continue to perfect your poetry thank you thank you I'm gonna hit your second point about predatory journals so this predatory journals uh you know you get these emails about dear Honorable dr. GC Huang which is clearly like pulled from MEDLINE that have arisen entrepreneurial II out of the pressure to publish it is really hard like I get these a lot and because the journal names are so close to something that sounds authentic I think there's a journal for Domenic medicines and if you didn't know you just you know and in the early days I definitely signed out to be on their editorial board when I was a young faculty member and it is really challenging it's a little bit like whack-a-mole so efforts that people have done to try to stamp this out on a systematic level have not really work I mean think capitalism that sort of allowed those to rise and I think the concern that I have is not only that people are being taken advantage of and that they're generating a lot of money but it's be it's almost beyond the bandwidth of promotion committees to go through citations and look for the legitimate ones and so they're probably scholars out there that are profiting from this it is really really challenging over time I've gotten a sense of the hallmarks of it the word honorable usually is a good sense or my last name before my first name but I think for novice or new faculty it is especially challenging I think one sign would be you know if you have to pay upfront and there's probably something there that suggests that it's not working but this is also had has been a disservice to other journals as well the first point about rejection is also hard the scope of my journal I work longer and harder on my rejection letters especially when they're trainees than I do on my acceptance letters or revised with resubmit there is a great and encouraging movement that trainees in particular are getting the attention of the journals because we see that their voices have tremendous value and perspective where you know I may have lost that and so I know academic medicine that had portals doing this a lot of journals in medical medical education are really trying to lift up the trainee voiced in that sense so specific author development initiatives to help them write and help them learn the skills of writing earlier it will always be a community of the elite you know I and I also suffer from this you know trying to get published as an educator my promotions committee insists that published in the New England Journal or JAMA a research paper in order to be considered for promotion and so there is remains a disconnect between the type of journal and who I am as an educator and the rejection rate certainly I would say as a positive spin that the journals are looking to open access so meted portal is an open access journal as a new avenue of growth so Jama Network open is a relatively new journal of the Jama series that has a higher acceptance rate this is true of PLoS ONE and BMJ innovations as well and so granted that there's a publication fee associated with them they do have the marker of very well-known prestigious journals and are finding a way to still publish in an online-only format some of the great work that's happening so I'm hoping that will balance a little bit of the extremely low acceptance rates we're seeing from the high-impact journals another questions Lucy hi um one of the things you mentioned was actually mention it twice now was about being an editor on a journal or an online journal and do you think there's value in that even as a young faculty who hasn't published much because I do you think I have an internal you know statement that like why are you editing other people huh you're still working at it on your own but does it allow for growth as well as a faculty member definitely the subject of a whole different talk but I I built my career on loving words and the editing process and so one potential trajectory that could go in parallel with your trajectory as an educator and leader and so forth is getting involved as an avid reader of the literature a peer reviewer an associate editor editorial board editor-in-chief and not everybody wants to be an editor-in-chief for sure our committee is for it full of very person it could be people for some reason but that is an avenue of growth that I think is really important and it gives you a window into the editorial process that you won't gain just simply by being overly of the work so set aside the negative voices like I'm not qualified enough and they're also roles like iYou know I worked with Dan Dressler with being an associate editor for journal watch and that tremendously grew my skills for writing and looking at the literature in a systematic way so I think what's great is hospital medicine has lots of opportunities to write those summaries of the clinical literature that can help your writing skills you'll get some feedback on it and then allows you to practice the work of writing so yes if they're editorial fellowships or associate editor positions put your name out there try so default a trap I often see people fall into is if I just do a little more I'll make it better and they keep working and they keep working and they don't quite know when it's time to actually put their neck out there and submit papers what advice might you have for people who are in that endless cycle of one more fix and it'll be better the other in response to the previous comment many journals now have programs where assistant professors in particular can be sort of trained to be associate editors they come on board as an apprentice to any IC or an AE and so they're not judging paper solo but they're doing it under the mentorship of an AE for a journal that sounds like a great program I know less about the second part that you had mentioned a parallel situation would be being mentored on a peer review so you may not necessarily get pure request peer review quests as a junior faculty member but for sure your senior faculty are and they may not have time to do it so ask if you can be mentored doing a peer review and you'll get a lot out of that process I do a lot of peer review mentored peer reviews and they learn about the editorial process the first question I think there are two tendencies the one is the enemy being the perfect perfect being the enemy of the good and sometimes it will take a reality check from that senior mentor to say and that is enough it's time to move on that's why I enforce the importance of a writing team because if you do this alone and I have papers where I'm the main driver they will never get done but I think this is the activation barrier I think calling out the fact that there's fear behind the decision to actually hit the button for submit is something that if we acknowledge it may help them get over perfectionistic tendencies for that but it's it's a really good point and I would say when you're investing time and submitting I feel like the last 5% is what takes 50% of the time or responding to reviewers comments also takes a tremendous amount of time sometimes longer than it took to write your whole paper so there's a lot of time that needs to be invested in the submission process no hushing about that and I know you didn't comment on this but you know again around the idea of harnessing energy rather than time is when I get those revision requests I try to act on them immediately or soon because three months down the road it will be extremely painful I've found that as a busy educator I'm often trying to manage the activation barrier to doing work not just publishing so thank you for your points just a couple of comments one the only thing worse than the shame of getting a rejection when you're a junior faculty member is the shame of the rejection when you are a senior faculty member when you get the desk rejection from the editor of academic medicine two days after you sat next to him at a meeting in Washington DC and you take that a little personally not that I have experienced the the second thing a corollary of what you were saying about feeling more accessible to to submit things one of the biggest problems that people have is they don't read the directions and I'm not saying this just because I spent 17 years teaching high school but don't read the directions they submit the wrong article format to an inappropriate Journal they do and they have great ideas but they get desk rejections because it's not the right place and so if people did a little bit more upfront work and send it to the right place it would get accepted and you don't have to go through that crushing receipt of the thank you for your submission we read it with great interest I would say the editorial process absolutely rewards those s's on the myers-briggs I you know the is TJ types because details are incredibly important whether it's punctuation luckily a lot of journals are going to submit it my way or some of it any way you want so a little bit more flexibility around formatting of punctuation and font and so forth but you're right you still absolutely need to go back to the instructions you talked a lot about the promotions process and I seriously comment you know I think that many people in medical education find that the more traditional promotions criteria often aren't recognizing sort of new forms of scholarship you know tweet Orioles comes to mind other kinds of workshops and so on excuse me comment on that and are there major academic institutions where there are sort of best practices around recognizing some of these alternative forms of medical education scholarship it's a great question um I don't know of the institutions that are I have a feeling that we will move towards evaluating valuing dissemination in complementarity with scholarship I don't think we'll ever leave the published paper as the coin of the realm but you know the concept of impact factor has been levied critique by many directions in many directions and so all metrics has been something available that can show the spread of your ideas and the work perhaps in a more meaningful way I would love to see era and maybe it's five or ten years down the line where the number of followers and your social media presence would be able to be measured in some way that demonstrates your impact as well we have flexible forms of the HMS institutional cv that allows us to talk about that but know there isn't a place that says you know how many followers you have and I'm hoping that will be an evolution for sure and I will also acknowledge you know if you are a researcher editorials will not matter at least for HMS CV so to me the first step is to learn to write and just start getting familiar with the publication process and then you know work towards the different kinds of publications that may have more value if promotion is an important goal for you but really great point