Discussion
The survey results reflect the current knowledge and suggestions for improvement.
It is good to know that nearly 81% of the candidates were aware of the recent MCI
amendment. The currently selected types of manuscripts like original articles are
rated high by the participants, scores being closer to 1. Majority of the participants
(93.4%, 170/182) expressed that all types of manuscripts should be recognized with
appropriate weightage. A second striking observation was regarding the position of
the authors. The participants wanted the best recognition for first and corresponding
authors, with lesser weightage for authors in other positions. We reviewed the relevant
literature under the following headings:
Current Practice in Indian Medical Colleges
All the MCI recognized medical colleges across the country mandatorily follow the
minimum guidelines for faculty promotion laid down by the MCI. These guidelines are
applicable for postgraduate teachers with qualifications including MD, MS, DNB, DM,
and MCh. There may be internal variations in the practices in autonomous institutes
such as the addition of average citation index and Journal Impact factor to the promotion
criteria recommended by the Sneh Bhargava-Committee[14] currently not a part of MCI guidelines, but the overall criteria cannot be lower
than the minimum guidelines already set by the MCI.
Modifications in MCI Amendment 2019
1. Number of publications
The latest amendment has reduced the requirement of number of publications for the
post of assistant to associate professor from two to a single research paper. Associate
professors will require three (at least two as associate professor) instead of four
publications for promotion to the post of professor.
2. Indexing agencies
For a publication to be counted toward promotion, MCI mandates that the article should
be in indexed journals, but there was ambiguity in the list of recognized indexes
in the previous amendments. For example, the first list of indexes in the 2015 issue
omitted certain reputed indexes, duplicated the names of the same type of database
(Medline and Index Medicus), and enlisted search engines like PubMed.[7] In the latest (2019) amendment, the updated list of acceptable indexing agencies
includes PubMed Central, Science Citation Index, Embase/Excerpta Medica, Scopus, and
IndMED.[2] This is a welcome move.
Clearly, the aim is to encourage publications in recognized databases that are reputed
to have quality journals and limit predatory publishing.[15]
[16]
3. Type of articles
In the 2017 guidelines, original research papers were the only type of publication
eligible for faculty promotion. Perhaps, the idea behind it is that “original research
articles” are the best type of publication and an ideal parameter to judge the research
output.
MCI has now included meta-analysis, systematic reviews, and case series in the list.
However, we note that multiple other types of publications such as review articles,
guidelines, pictorial essays, opinions, case reports, brief reports, and letters to
the editor continue to be ignored and not included. Book chapters are also not considered.
These types of publications are more in number, sometimes have a higher number of
citations, are a valuable contributor to the knowledge pool, and serve as motivation
for publications.[17] Not giving importance to them discourages the aspiring authors to share their learning
and experiences.
In the Indian scenario, due to the multiple challenges, it may not be possible for
medical faculty in all specialties to generate multiple best quality or “ideal” publications
such as original articles in indexed journals. One such challenge is where there are
very few journals covering a specialty. Another is that each journal accepts a limited
number of different categories of manuscripts. Case reports, pictorial essays, and
brief reports may be the way for authors to share the knowledge from rare cases that
may not be in a sufficient number to create an original article, especially in smaller
or peripheral institutions or from a single institution. Letters to the editor constitute
an extremely important segment for sharing of ideas and raising pertinent points to
a recent manuscript and would be especially useful for authors from smaller setups
to share their novel experiences about a standard approach/treatment regimen.
4. Position in authorship sequence
The 2017 amendment gives credit to only the first and corresponding author. The idea
is perhaps to avoid gift authorships to the other authors because generally the majority
of the work is done by the initial authors.[18]
[19] This rule has been relaxed in the latest circular and the author must now be among
the first three or should be the corresponding author.
We appreciate this step as it encourages contribution by multiple authors, promotes
healthy interdisciplinary collaboration that should ultimately help bring out good
quality work. However, the contributions of the rest of the authors lower down on
the list continue to get neglected. Often, the senior teachers who mentor and supervise
the work of junior doctors put themselves at the end of the list, so it is unfair
to assume that the authors lower down the order did not contribute. In fact, the last
author is increasingly being credited as being the guarantor of a study[19]
[20]
5. Inclusion of electronic journals
None of the previous guidelines considered the publications in e-journals for academic
promotion. Unfortunately, this excluded many high-quality popular indexed journals
with impact factor that are only available online. Some journals are purely in electronic
format or have different content in the hard and electronic copy formats.[7]
[21]
The publishing trend is switching from hard copy to the electronic format due to cost
factor, space, and ease of access. Hard copies may not be always available for the
readers in libraries in all institutions. A majority of learning now happens online
on personal gadgets; visits to the library and borrowing journals are passé. Sometimes
issues regarding the printing of hard copies may arise; for instance, the coronavirus
disease scenario has put the publishing of print issues on hold and the new publications
are increasingly being made available as soft copies.[22] Most of the electronic journals have the option of displaying the manuscript online
ahead of the issue with an assigned digital object identifier (DOI), which enables
quick dissemination of knowledge. DOI even enables further citations even before publication
date.
MCI has now included publications in the directory of open access journals (DOAJ)
along with other databases. DOAJ is a freely available, digital online directory that
indexes and provides access to high quality, open access, peer-reviewed journals.[23] This allows a much wider range of journals for the faculty to choose from, for publishing
their work.
6. Removal of “specialty,” “national,” and “international” journals
The 2017 amendment included “national” or “international” journals in the eligibility
criteria. Several articles pointed out that since indexing had already been included
as a criterion, separate mention of these terms did not have any added value.[6] The 2019 guidelines have made note of this and have only given importance to indexed
journals regardless of nationality. The criteria for “specialty” journals have also
been removed, which will encourage multidisciplinary and multicenter collaboration
for research.
7. Noninclusion of other pillars of education: service and teaching
MCI amendments give importance to publications (number and type) for assessing medical
faculty for promotion. However, it discounts achievements and prowess in clinical
or laboratory/imaging services and teaching, which are the core responsibilities of
medical faculty. The pressure to give disproportionate importance to research output
for assessment and not giving due consideration to other aspects of their duty negatively
affects the purpose of teaching and service. It results in a desperate need for publications
for promotions, leading to poor quality publications in “predatory journals.” It also
creates stress and leads to below standard research. A good teacher could potentially
be considered “inferior” to a colleague with a higher number of publications and thus
promoted to a higher designation.
7. Two years’ transitory period
The time interval between amendment notification and the faculty appointment or promotion
of two years is appreciable, as it allows the new guidelines prospectively applicable
to the new promotions and there is no threat to the positions of the teachers, whose
promotions were as per the old guidelines. The already existing publications or those
accepted for publication before the notification will also not be affected.
Our Suggestions
1. Scope for a scoring system ([Table 3])
Table 3
Suggestions for publication criteria for medical promotions
|
Proposed modifications
|
|
Objective criteria: Inclusion of scoring system
|
Appropriate weightage to:
All types manuscripts
All authors
Indexed as well as non-indexed journals
Impact factor of the journal
Specialty journals
|
|
Weightage to total number of citations for each author and each paper: Inclusion of
citation indices and Indexing service such as Google Scholar
|
|
Introduction of minimum publication guidelines with international equivalence
|
|
Common minimum publication guidelines for faculty promotion in university accepted
fellowship programs
|
|
Inclusion of criteria to assess the quality of a medical teacher with regard to service and teaching
|
The criteria for promotions should include the quality of publications and not just
their quantity. The DCI (Dental Council of India), a parallel medical education system,
already has a point system in place regarding the types of publications for academic
promotions.[24] Why not take a cue from it and adopt a similar system as an objective method to
quantify research productivity?
We propose a scoring template to rank the quality of publications based on both participants’
scores and input from the authors ([Table 4]). For example, although the survey results suggest an average score of 0.5 to case
reports making two case reports cumulatively equivalent to an original article, the
authors suggest a lower score of 0.2 per case report. We also propose that in the
place of currently accepted “one publication,” “one score” can be used as criteria
for promotion. The ideal scoring should be inclusive, reasonably simple, support the
career growth of the faculty, and encourage publications.
Table 4
The proposed weightage-based scoring system (1= best score)
|
Type of manuscript
|
Author position
|
Specialty
|
Index
|
Journal impact factor
|
Recommended score
|
|
Abbreviation: MCI, Medical Council of India.
|
-
Original articles
-
Systematic reviews
-
Meta-analysis
-
Case series
|
First/corresponding
|
Same
|
MCI recognized index
|
More than one
|
1
|
-
Original articles
-
Systematic reviews
-
Meta-analysis
-
Case series
-
Book chapters
|
Second or third author
|
Same
|
MCI recognized index
|
More than one
|
0.8
|
-
Pictorial essays
-
Case reports
-
Technical reports
-
Book chapters
|
First/corresponding
|
Same
|
MCI recognized index
|
Less than one
|
0.5
|
-
Case report
-
Letter to the Editor
-
Short communication
|
First/corresponding
|
Other specialty
|
MCI recognized index
|
Less than one
|
0.3
|
-
Original articles
-
Systematic reviews
-
Meta-analysis
-
Case series
-
Case report
-
Letter to the Editor
-
Short communication
|
Rest of the authors (other than first or corresponding)
|
Other specialty
|
MCI recognized index
|
Any
|
0.2
|
|
Any
|
Any author
|
Any
|
Nonindexed
|
Any
|
0.1
|
Any publication in a recognized index has value and should be acknowledged, as having
some publication is better than none. A maximum score of 1 can be given to original
research, meta-analysis, and systematic reviews in indexed journals as these are the
ideal publications one should aim for. A minimum score of 0.1 would represent a publication
of low academic value, with no additional information, perhaps in a nonindexed journal.
Textbook chapters should also be given some weightage, as medical students often rely
upon textbooks more than research articles as their preferred reading source for basic
and comprehensive learning of the subject. Multiple publications of a lesser score
in different formats can then be given a cumulative score together, to make them equivalent
to one “ideal” publication. This will reflect the efforts of the author and also show
the continuous academic activity of the author in terms of publications.
Similarly, all authorship should be acknowledged and points can be given based on
the contribution and serial order in author sequence. A maximum score can be awarded
to the first and corresponding authors and lesser scores to the remaining authors.
This can address the uncertainty in the authorship criteria persisting over the years,
prevent the pressure of gift authorship, and encourage multidisciplinary and multi-institutional
research.
Some journals allow dual or joint first authorship.[25] There is no mention in the existing MCI guidelines regarding recognition or weightage
for joint first co-authors. We feel that an equal weightage can be given to joint
first authors, preferably for original articles of multidisciplinary nature. We assume
that an equal contribution by authors would have been justified and subsequently approved
by the editorial committee. Hopefully, this should not be considered as an opportunity
to achieve a higher number of authors than what MCI is currently accepting for promotion.
Nonindexed journals, journals with low impact factor (of less than one), and non-specialty
journals though of lesser quality, can be incorporated into the scoring system and
given a minimum score.
It is interesting to note that 12/182 (6.5%) of participants have suggested a zero
score (nil weightage) for publications. One cannot be sure of their reasoning, but
these teachers are likely of the opinion that there is currently undue importance
given to publications for promotions.
2. Journal impact factor score
Impact factor does not feature in any of the MCI amendments, though it is recognized
worldwide as an objective criterion to assess the quality of different journals based
on citation data. A value of more than one is considered as an internationally competent
and influential journal, irrespective of the country or index of publication.[26]
[27]
[28] We suggest that this can also be incorporated into the scoring system and publications
be given appropriate points based on the numerical value of impact factor of a journal.
3. Inclusion of citation indices and Google Scholar as a Citation Indexing Service
Impact factor measures the overall quality of a journal, but not the scientific impact
of an individual article or author. These can be assessed by the total number of citations
(from all published material) and citation indices such as h-factor and i10 index.[29] Google Scholar is a freely-accessible online indexing service that includes scientific
journals as well as nonjournal sources such as books, dissertations, and conference
papers in its database. It can determine the total number of citations and rank them
for each author (quantity) and each paper (quality).[30] The number of times a publication or an author has been cited per year using Google
Scholar can be taken into consideration for the assessment of faculty promotion.
4. Criteria for further grading within a category of faculty
The present guidelines address the publication criteria only at two senior levels:
associate professor and professor. In some institutions, the associate professor is
promoted to an intermediate position of “additional professor” before becoming a professor
based on the years of experience.[31] We feel that certain publication criteria can be introduced at this level as well.
5. International and universal
There is a wide diversity in the guidelines for faculty promotion in foreign universities,
based on the information available on some of their web sites. Many institutes give
due consideration to research activities, teaching as well as clinical skills and
not just the number of publications. Some give equal weightage to all authors irrespective
of their sequence in peer-reviewed papers, case reports, letters to the editor, syllabus
materials, commentaries, review articles, book chapters, videos, and letters to the
editor.[32]
[33,34] In some institutes, faculty is appointed separately in either research or teaching
and there is no requirement for formal teaching or clinical care in the research line.
It may not be possible for us to have universally applicable guidelines, but at least
it would be great if “common minimum” guidelines be achieved, so that the qualifications
of our teachers in terms of research can be aligned with the accepted standards for
the similar job positions overseas.
6. Assessment criteria for service and teaching
We believe that the other important facets of a physician–teacher—service, teaching,
and mentoring, which have not been taken into consideration for promotion (along with
years of experience), should definitely be seriously considered. These may include
teaching skills, examination duties, fellowships, service record, and other academic
achievements such as awards, patents, collaborations with projects, grants brought
to the institution, orations, guest lectures, organizing conferences, the performance
of students, and their feedback. Mentoring postgraduate students for dissertations,
reviewing manuscripts, and working as an editor should also be considered as a part
of research activities. We can adopt criteria similar to the already existing academic
performance indicators scores devised by the UGC for other fraternities.[35]
7. Common minimum guidelines for faculty in other streams of higher medical education
The new MCI guidelines apply to teachers in institutes with DNB and DM/M.Ch. super
specialty courses as well. We need clarity regarding how exactly to translate academic
positions between these two streams. Apart from them, there are institutes with only
university accepted fellowship programs, without undergraduate or postgraduate courses.
The faculty of such institutes also contributes to the pool of medical teachers and
should have a defined publication criterion.
