The above investigation of publication patterns in clinical and related health science fields has confirmed the increasing tendency of South African clinical researchers to publish their best work in ‘international’ journals, and particularly in a wide variety of specialty journals. The total number of ‘clinical health sciences’ articles published worldwide from South Africa every year has recently begun to decline, and much of the authorship is provided by an ageing cohort of established researchers. The few remaining health sciences journals have understandably migrated to a varying mix of first-submission original articles, summarised ‘lectures’ relating to continuing professional education, popular reviews, practitioner-directed features, house journal functions, a plethora of advertising, and articles repeatedly refused elsewhere.
First-submission reports of good clinical research do not fit into this design, and so the country’s productive clinical researchers live vicariously in the heavily North-oriented global system. what this says about the local culture is that it is fragmented by specialisation and is heavily overseas-orientated. Such a system is poorly positioned to inspire a new generation of younger clinical scientists unless the previously described ‘iceberg’ effect, reflecting a well- functioning domain of intensive seminars, interdisciplinary collaboration, well- organised local conferences and exciting graduate programmes is actually
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operative. This kind of infrastructural health is unlikely given the well-recorded pressures on clinical researchers caused by increases in service pressures, administrative burdens and teaching responsibilities (partly due to the shrinking participation of part-time specialists as bedside tutors).
This report recommends elsewhere measures to address the optimisation of research training, development, multi-sector support and systemic policy change. In this section, only the topical issue of one or more local journals reporting original clinical research of high quality is raised.
We contend that a sufficiently large number of clinical research papers is produced every year to permit the operation of a local (or regional) journal dedicated to clinical research, if it is properly established, edited, supported and marketed, and is placed at the core of a reinvigorated clinical research community.
The South African Medical Journal (SAMJ) has an outstanding record as an internationally recognised, high-impact, general medical journal. It has, however, deliberately re-positioned itself in recent years as a mixed-content journal in which peer-reviewed articles constitute only about 20–25% of the total contents, and these are restricted editorially to articles which directly address health problems or are practically useful to general medical or public health practitioners. This approach has retained the interest of its readership.
The infrequently appearing ‘specialist daughter’ journal titles of the SAMJ do not feature anything like the cream of the country’s clinical research articles in their pages.
The 2006 ASSAf Report on A Strategic Approach to Research Publishing in South Africa made a strong general case for the publication of indigenous, high-quality journals, showcasing local activity and contributions, fostering coherence of the local research community, supporting the training of a new generation of high-quality researchers, and providing ample opportunities for intellectual growth of local scholars as editors, peer reviewers and contributors (Gevers et al., 2006). Examples of successful (mostly open-access) journals in the clinical sciences can be found in India (e.g. Indian Journal of Medical
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Research, MEDNOW), Brazil (Brazilian Journal of Medical and Biological Research), Mexico and China.
It is thus possible that enhancement of clinical research in South Africa will not be possible without a ‘flagship journal’ published locally to the highest standards, promoting the coherence of the field, and visibly incentivising young researchers to develop to their fullest potential. The proposed journal could also sponsor annual research conferences, and be aligned with a national society for clinical research. The journal would need to seek indexing in the same international databases in which the SAMJ currently appears.
In this way it would rapidly become an ‘international journal’ in the sense of promoting the reputations, rewards and funding opportunities of its published authors, while simultaneously enriching and enhancing the local clinical research community, especially its young members. Accreditation by the Department of Education in terms of its research outputs policy would automatically follow.
It is therefore reasonable to propose that the South African Medical Association (SAMA) be urgently requested to explore the possibility of publishing a new, open-access journal/daughter journal dedicated to high-quality clinical research, across the sub-disciplines in the field (South African Journal of Clinical Research). Alternatively, such a journal could be started independently through a joint initiative of interested stakeholders.
Such a journal should appear at least bi-monthly, and be edited by a competitively appointed, part-time, contract Editor-in-Chief, assisted by an appointed team of part-time, contract Associate Editors (including foreign- based clinical researchers of high standing), each responsible for particular selected sub-topic areas. The journal should maintain the highest possible standards, market itself energetically and professionally for article submissions and readership throughout Africa and the rest of the world, and contain added-value features such as editorial comment on key articles, authoritative reviews, scholarly correspondence, as well as accessible summaries and (English-language) formal abstracts of each article. Indexing in Thomson Reuters ISI, Medline and Google Scholar should be sought, and permission to authors to deposit their articles in institutional repositories granted.
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The leading role of multidisciplinary clinical journals such as the New England Journal of Medicine, The Lancet and the British Medical Journal show that readers and contributors active in sub-specialties are ready to share their best work in high-quality periodicals, and, in turn, it is these which enrich their perspectives, generate fruitful collaborations and inspire young entrants to the otherwise daunting, uphill world of clinical research.
Multidisciplinary cohesion and synergy in the execution and reporting of high-quality research are also well-characterised features of successful departments and research units/centres/institutes. Extending this to larger contexts, in regional and even national concentrations of researchers, can be a highly effective way of increasing the productivity and impact of local teams, and of fostering a new generation of motivated and well-trained scholars. A modern journal that reflects the best thinking of the best clinical researchers, that is well-edited with sparkling enhancement features, and that becomes a regional flagship, is a prerequisite for such a vision.
FINDINGS
1. While South African scientific publishing represents a small fraction of world output, it comprises a large proportion of scientific research on the African continent.
2. Clinical research has formed an important part of South Africa’s scientific output in terms of quality and quantity.
3. Although the number of clinical medicine journal articles has declined since 2003, nearly half of the fields in clinical research have recorded above-average field-normalised and journal-normalised citation rates for the period 2002 to 2006.
4. The trend has been towards increased publication of clinical medicine journal articles in international journals, and particularly in a wide variety of specialty journals.
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4. Although more female and black authors have been publishing than before, progress has been slow and the proportion of older authors has been rising.
RECOmmENDATIONS
1. Promote publication of high-quality clinical research in local, especially multidisciplinary journals.
2. Change institutional cultures to promote local publication, for example by recognising and rewarding publication in both local and international journals of high quality.
3. Increase opportunities for local publication, for example through estab- lishing vibrant supplements to existing journals and/or establishing a new, open-access, multidisciplinary journal for clinical research, possibly as a
‘daughter’ of the existing flagship, the South African Medical Journal.
4. Create a national society for clinical research.