Clinicians’ Publication Output: Self-Report Survey and Bibliometric Analysis
Round 1
Reviewer 1 Report
In all, this is a well written article that I fully support for publication. I only have minor comments to make about this article, in order to improve some of the content:
The following minor spelling errors should be addressed:
[1] PUBMED should be all capital letters. The conventional spelling is PubMed (lines 19,90, 108, 129, 145, 167, 188, 197, 240, 377). [2] PsychInfo is mispelled in line 129. [3] To be consistent throughout the article, Scopus should not all capital letters (Line 384)
I would suggest one addition keyword, being that this was country-specific research project: Maylasia.
In line 107, it was mentioned that the survey was administered in English. It would be a good idea to include additional information on why English was chosen as the languge for the survey.
For lines 132-138, this is very minor sugestion. You may want to consider numbering the item mentioned in line 132, which are then listed starting in the next sentence. This would make the individual items easier to identify within the text.
In line 199, reviews are mentioned as a type of scholarly publication. Even though this sentence is a citation, could you clarify if reviews also includes systematic reviews and meta-analyses?
In line 140, the citation mentions previously published studies. You may want to consider mentioning the individual first authors within the sentence, to help further clarify who is being cited.
In line 211, a keyword analysis of using MeSh (PubMed/Medline's Medical Subject Headings). Two suggestions of clarification are being asked for:
[1] Defining to the reading what MeSH terms are. [2] Providing more detail on why MeSH were choosen for this analysis.
In line 298, previous studies from Japan and the United States are mentioned and cited. Please consider providing more information about these studies within the sentence or paragraph. This will better help the reader understand the comparison without have to go to the bibliography.
In line 343, again, please provide more information within the text reagrding the cited information.
Section 4.2 Finding from Bibliometric Anaylsis (beginning on line 349). The summary would be much stronger if you included some of the statistics from your overall analysis within this paragraph. It would help some readers who would first look at the analysis before reading the article to decide if they would like to read the full article. It should be a reflection of the information included within the abstract.
Author Response
Reviewer Comment 1:
In all, this is a well written article that I fully support for publication. I only have minor comments to make about this article, in order to improve some of the content.
Author’s Response:
Dear reviewer, thank you very much for your encouragement and suggestions to further improve the paper. We agree with all your comments and have revised the manuscript accordingly.
Reviewer Comment 2:
The following minor spelling errors should be addressed:
[1] PUBMED should be all capital letters. The conventional spelling is PubMed (lines 19,90, 108, 129, 145, 167, 188, 197, 240, 377). [2] PsychInfo is mispelled in line 129. [3] To be consistent throughout the article, Scopus should not all capital letters (Line 384)
Author’s Response:
Thank you for pointing out these errors. We have rectified all of them: PUBMED changed to PubMed throughout the manuscript. PsychInfo and Scopus have been corrected at the relevant lines.
Reviewer Comment 3:
I would suggest one addition keyword, being that this was country-specific research project: Maylasia.
Author’s Response:
Thank you for your suggestions. We have added the keyword “Malaysia.” However, please kindly note that Reviewer 3 has requested that keywords which are similar to the words in the title to be deleted. As such, we have only 3 keywords now.
Reviewer Comment 4:
In line 107, it was mentioned that the survey was administered in English. It would be a good idea to include additional information on why English was chosen as the languge for the survey.
Author’s Response:
The questionnaire was administered in English, given our sample cohort that consists of professional practicing clinicians preferred communicating in English in line with their routine medical practice.
We have modified this line to be as follows:
The questionnaires were administered in English, given our sample cohort consisting of professional practicing clinicians who preferred communicating in English that was in line with their routine medical practice.
Reviewer Comment 5:
For lines 132-138, this is very minor sugestion. You may want to consider numbering the item mentioned in line 132, which are then listed starting in the next sentence. This would make the individual items easier to identify within the text.
Author’s Response:
We have numbered them as suggested.
Reviewer Comment 6:
In line 199, reviews are mentioned as a type of scholarly publication. Even though this sentence is a citation, could you clarify if reviews also includes systematic reviews and meta-analyses?
Author’s Response:
Dear reviewer, thank you for your comment. We certainly agree with your query here. To be consistent with response to Reviewer 2, Reviews here include systematic-reviews, meta-analysis, scoping reviews or rapid literature review. Book reviews were excluded. These are described and defined between lines 128 and 129, under primary outcome measure sub-section.
Reviewer Comment 7:
In line 140, the citation mentions previously published studies. You may want to consider mentioning the individual first authors within the sentence, to help further clarify who is being cited.
Author’s Response:
We have mentioned first author names for the references cited.
Reviewer Comment 8:
In line 211, a keyword analysis of using MeSh (PubMed/Medline's Medical Subject Headings). Two suggestions of clarification are being asked for:
[1] Defining to the reading what MeSH terms are. [2] Providing more detail on why MeSH were choosen for this analysis.
Author’s Response:
Dear reviewer, thank you for your comments and suggestions. Kindly allow us to justify our decision to use MeSH terms in this study. MeSH (Medical Subject Headings) terms are very important to retrieve keywords of studies related to medical research or diseases. Moreover, MeSH is being used by ClinicalTrials.gov for classification purposes. Our main aim was to explore research works related to medical or clinical related that were conducted by clinicians. It would have become useless if we explore studies of non-medical related ones from keywords retrieved that were not MeSH terms during bibliometric analysis for our study sample, clinicians who are involved in medical/clinical research.
We have added the following description to address your comments:
MeSH defined as Medical Subject Headings is used by both MEDLINE/PubMed and ClinicalTrials.gov for indexation of medical articles and classification of diseases that are being studied in clinical trials respectively. It was crucial to use MeSH terms for bibliometric analysis in this study given the study objectives that intend to analyze publication output related to medical research or clinical trials conducted by a selective group of sample, namely practicing clinicians in our hospital.
Reviewer Comment 9:
In line 298, previous studies from Japan and the United States are mentioned and cited. Please consider providing more information about these studies within the sentence or paragraph. This will better help the reader understand the comparison without have to go to the bibliography.
In line 343, again, please provide more information within the text reagrding the cited information.
Author’s Response:
For references cited in line 298, the following editions were made and further descriptions were added:
This association was inconsistent with previous studies from Japan [20] and the USA [30]. These two studies were specifically focused on urology trainees that had a paper published during their residencies or postgraduate trainings. The studies predicted that urologist capacity to have more papers published will escalate overtime as seniority increases.
Dear reviewer, as for line 343, the reference sentence was self-explanatory informing that the findings of our study which found that preferences on peer reviewed, open access, impact factored, speed, manuscript acceptance rate and international journals were key selection attributes to significantly influence clinicians’ scientific publication output. These findings were consistent with those studies. Unlike line 298 that found inconsistencies with previous literature, and that adding further descriptions will definitely accelerate more meaningful interpretations, we felt that if we were to follow suit for line 343 by describing the finding of previous literature, it will have redundant meanings of interpretations as the findings of our study were consistent with those literature. As such, we have maintained the original sentence. We hope you would agree to our decision here. However, if you feel that it still needs to be changed, we will do.
Reviewer Comment 10:
Section 4.2 Finding from Bibliometric Anaylsis (beginning on line 349). The summary would be much stronger if you included some of the statistics from your overall analysis within this paragraph. It would help some readers who would first look at the analysis before reading the article to decide if they would like to read the full article. It should be a reflection of the information included within the abstract.
Author’s Response:
Thank you for your suggestions. We have added core relevant statistics from the bibliometric analysis part. Kindly note that Reviewer 2 has requested further description to this section and we have added them, the relevant findings were included in those parts as well.
Overall, we would like to thank you for your encouragement and suggestions to improve the paper. We hope that you would be satisfied with our revised paper and responses to your comments. If there are any further revisions required, we will be happy to address them.
Reviewer 2 Report
Comments on Ms.: Clinicians publication output.
General comments.
This submission is a slightly odd paper. It describes a small-scale study which documents the outputs of a small group of clinicians at a single hospital in Malaysia, and relates these outputs to the clinicians’ responses to a short questionnaire. The data reported is not without interest, but the paper does not contextualise the findings, or explain why they might be of interest to a wider, international audience. The paper also lacks any kind of theoretical framework which would provide a rationale for the study.
I am therefore recommending that you reject this paper for publication in the journal. However, you might recommend to Authors that it would be publishable in a different outlet, provided that the text is reviewed by a competent native speaker of English.
I have provided some detailed comments below that I hope will be of use to Authors in any re-drafting that they undertake. These comments mostly concern places where I thought the text was a bit brief and where further information might be needed for readers to follow.
Detailed comments.
P1 ln 2 Authors publication ... should be Authors’ publication …
p2 ln 85. I felt that most of this introduction was not relevant to the data that is reported in the following sections.
P2 ln 90 I haven’t worked with bibliometric data from PubMed, so I would have liked some more detail about how this database is constructed. e.g. does it only list papers by first author like some other databases? What is its coverage?
P2 ln91 Likewise, I am not familiar with hospitals in Malaysia and I would have liked more information about this institution. Is it a large teaching hospital? Is it a major research centre, or a small regional one?
P3 ln98 My guess is that some readers may not be familiar with the Helsinki Declaration. Cf also the Belmont Principles referred to later in the text.
P3 ln111 The occupation designations need to be explained in more detail. The grades mentioned on ln 114 and 115 will be meaningless to readers who are not familiar with Malaysian practice.
P3 ln119 Reviews is ambiguous as to whether it refers to book reviews or systematic reviews of a research field.
P3 ln123 Why was this hospital chosen as the focus of this study? Is it typical of centres of this type in Malaysia, or does it have any special characteristics that might affect the results? Why were these two cut-off dates chosen? Given that we are now in 2020, is PubMed fast enough to have logged all the relevant work published in 2019? (I usually reckon that the standard databases can’t be relied on for a timely log of work published in the previous two years. So personally, I would have ruled out publications from 2018 and 2019 from the analysis.)
Does Hospital Seberang Jaya have any alternative designations?
P3 ln126 Where do these five habits come from? What makes them interesting?
P4 ln138 how was the five point scale dichotomised?
P4 figure 1 This figure led me to expect a full Structural Equation model.
P5 ln175 Is this figure of 234 a sample from a larger number of clinicians? If so, what criteria were used to reach 234?
p5 ln184 see previous comments on the Helsinki Declaration.
P5 ln186. Does this mean that 16.9% of the 201 participants had a publication? If so, the effective group size is only about 35, and I’d guess that these people were mostly men.
P6 Table 1 “aware about major indexing databases” is a bit vague. Maybe some people who are aware of them have never actually consulted the databases?
P6 ln 195 table 2 See previous comment about dichotomising the Likert scales. I don’t understand what this table is supposed to be telling me.
P7 ln197. 55 records is a tiny number of papers for a bibliometric analysis. It’s also small in relation to the number of clinicians in the cohort. It means that most participants had published nothing during the assessment period. Is this normal for a research centre of this kind? How does this figure compare with similar surveys in other fields? (Do Authors know about Lotka’s Law?)
P7 ln198 See previous comment on reviews.
P7 ln203 The text needs to tell me why Authors think co-authorship is important.
P7 ln207 The two most productive authors in this figure are also authors of the paper. Is there an agenda here?
To publish 14 papers over a 10 year period is not actually a large number. Is this typical of medical research in Malaysia? (I also wondered if the choice of source journals ruled out papers that were not published in English?)
The names will be unfamiliar to most readers.
P8 ln217 How should I interpret these data? Do they reflect the relative strengths of research groups in the Hospital, for example?
P9 ln224 This analysis was extremely difficult to follow. It might make more sense to do a structural equation analysis, and present the results in a graphic format.
P11 Table 6 what does Ref refer to?
P11 ln264 The text needs to explain why it is useful/interesting to compare consultants in Malaysia with students in Columbia.
P12 ln286 This claim needs a proper source.
P12 ln300 The “Matthew effect” isn’t a theory.
P12 ln304 An example might help
p12 ln316 See previous comment about the Columbian medical students.
P12 ln324 It is indeed a novel finding, but Authors need to show why it is important rather than just curious.
P13 ln338 The text needs to explain why the Berlin conference is important.
P13 ln350 This analysis needs to appear closer to figure 2.
p14 ln380 What kind of testable hypotheses do Authors have in mind?
Author Response
Reviewer Comment 1:
This submission is a slightly odd paper. It describes a small-scale study which documents the outputs of a small group of clinicians at a single hospital in Malaysia, and relates these outputs to the clinicians’ responses to a short questionnaire. The data reported is not without interest, but the paper does not contextualise the findings, or explain why they might be of interest to a wider, international audience. The paper also lacks any kind of theoretical framework which would provide a rationale for the study.
I am therefore recommending that you reject this paper for publication in the journal. However, you might recommend to Authors that it would be publishable in a different outlet, provided that the text is reviewed by a competent native speaker of English.
I have provided some detailed comments below that I hope will be of use to Authors in any re-drafting that they undertake. These comments mostly concern places where I thought the text was a bit brief and where further information might be needed for readers to follow.
Author’s Response:
Dear reviewer, thank you for your comments. We truly appreciate your constructive criticisms and suggestions to further improve the paper. We have addressed all your comments and edited the manuscript accordingly wherever possible. Our revision has taken into account the comments from Reviewers 1 and 3 respectively and we have made the changes to be consistent with these reviewers request as well. While reviewers 1 and 3 have mentioned that the paper is well reported and the study was well conducted, we did not make changes to the statistical analysis and results reporting and the overall content of the paper. We have justified our actions where appropriate with your comments below. The other two reviewers have also reviewed the English and recommended mild language corrections, thus we followed their suggestions on areas where minor language edits were required. On another note, Figure 1 contextualize a multifunction diagram, being a path diagram to determine appropriate variable selection at the same time forms the conceptual framework of the study. We have explained the uniqueness of DAG below. Limitation of a single center study has been acknowledged in the limitations part. We have made all relevant corrections where appropriate. We hope you would be satisfied with the revision of our paper.
Reviewer Comment 2:
P1 ln 2 Authors publication ... should be Authors’ publication …
Author’s Response:
Dear reviewer, thank you for your comment. We used the term “Clinicians publication” instead of “Authors publication” in the title. Therefore we believe that you were referring to the word “Clinicians.” We have rectified as “Clinicians’ publication” as suggested.
As you were referring to our study sample to “Authors,” we were concerned that you may have misinterpreted our actual study sample in which the study was conducted, therefore prompting your curiosities and concerns further to list multiple comments for this paper. In general, conventional scientific output papers, bibliometric or scientometric studies often refer “Authors” to academics. Most of your comments in the following sections seemed to be related to academic researchers conceptually rather than being related to our study sample, which is specifically referred to “practicing clinicians.” Practicing clinicians are not directly involved in academic teaching and their main practice is evidence based medicine, and their research practice and exploration for evidence are related to medical research, interventions and clinical trials specifically. Therefore, the exploration of scientific publication output, bibliometrics and factors associated with them have to be carefully crafted and analyzed to be suited for our study sample within the medical practice.
Reviewer Comment 3:
p2 ln 85. I felt that most of this introduction was not relevant to the data that is reported in the following sections
Author’s Response:
Ln85 was our study objectives. It was similar to the ones reported in the abstract and being in line with the title and main outcomes of the paper.
Kindly allow me to further justify our introduction. The introduction was crafted in such a way that it begins with an alarming example that clinicians face while encountering an unexpected disease epidemic and how to manage and tackle such threats that require new evidences for practice. Evidences are relied upon research findings disseminated through publications, and we specifically focused on the importance of publication output, the efforts taken by major open access publishers to make papers freely and immediately available for knowledge dissemination in clinical practice. We justified the “professional must” for clinicians to publish and we described the overall publication scenario and research activities of medical publishing in Malaysia. We then described the impediments for medical publishing (such as rejection rates, costs, publishing models, etc) and bibliometric databases that measure the quantity and quality of papers published. We finally reached our Ln 85!
The objective of this study required us to execute the study based on two main approaches; that is a bibliometric analysis to validly measure and explore the quantity of papers being published from our institution, what type of papers were being published, who worked with them (co-authorships), collaborations and common works being done. We needed to perform this to overcome the issue of veracity, which will surface if only a questionnaire was administered. Now that we have understood the medical publishing scenario in Malaysia, we wanted to further explore on what factors influence clinicians to publish? The best way to study this research question is to understand their views and choices through a self-administered questionnaire on items related to the research and publication process.
As we believe that such crafting of the introduction and study objectives are essentially important, and together with the support of the other two reviewers for this paper, we have maintained our introduction as such. We hope that you would be satisfied with our explanations here.
Reviewer Comment 4:
P2 ln 90 I haven’t worked with bibliometric data from PubMed, so I would have liked some more detail about how this database is constructed. e.g. does it only list papers by first author like some other databases? What is its coverage?
Author’s Response:
Dear Reviewer, in principle, bibliometric analysis could only be conducted using 1 database at a time and the most commonly used ones are Web of Science (WOS), PubMed and Scopus. Bibliometric software such as BibExcel and VOS Viewer could only facilitate data retrieved from 1 database. We are exploring bibliometrics from the medical research perspective, a single country, yet a single hospital amongst clinicians which are being representative for a state in Malaysia. We believe PubMed has a wider coverage as even the top two medical journals in Malaysia; namely The Medical Journal of Malaysia (website: http://www.e-mjm.org/) and Malaysian Journal of Medical Sciences (website: http://www.mjms.usm.my/), and a specialty journal, Malaysian Orthopedic Journal (website: https://www.morthoj.org/) are indexed in PubMed. We do not want to miss any papers that were published in local journals either. In addition, retrieving data from PubMed is free. Subsequently, PubMed website allows us to retrieve keywords from MeSH (Medical Subject Headings) terms, which are very important to retrieve keywords and studies related to medical research, which is the principle key of our work. It would have become useless if we explore studies of non-medical related ones from keywords retrieved that were not MeSH terms during bibliometric analysis. Regarding your query of whether PubMed only lists first author, the answer is no. It lists all authors. The era of medical publishing in Malaysia has set certain key performance indexes for scientific output, that is papers are regarded has having high merit if they were published in journals indexed in PubMed, Scopus or ISI Web of Science. Based on the reasons above, we believed that PubMed will be the most suitable database to retrieve data for bibliometric analysis in our study.
Reviewer Comment 5:
P2 ln91 Likewise, I am not familiar with hospitals in Malaysia and I would have liked more information about this institution. Is it a large teaching hospital? Is it a major research centre, or a small regional one?
Author’s Response:
We have added the following description under section 2.1 (study sample and setting).
The hospital oversees and administers three other satellite district hospitals and ten primary care clinics within the region, collectively catering to a population of about 900,000 people simultaneously [6]. Apart from providing core patient care and speciality medical services, it is one of the most active prime sites for clinical trials and medical research in the Northern Region of Malaysia [16]. Medical research is mainly handled by clinicians, pharmacists and nurses through the established CRC within the hospital.
Reviewer Comment 6:
P3 ln98 My guess is that some readers may not be familiar with the Helsinki Declaration. Cf also the Belmont Principles referred to later in the text.
Author’s Response:
The Helsinki Declaration and Belmont Principles are the ethics and principle guidelines for conducting and reporting research findings that involve human subjects in medical research. Every clinician or healthcare worker who intend to conduct studies involving human subjects are required to undergo Good Clinical Practice certification which is a standard practice worldwide. They are exposed to the main pillars of Belmont Principles (respect for persons, beneficence and justice) and Helsinki Declaration (ethical principles of research in human subjects). Ln 98 is our ethics approval statement and we needed to report as such. The subsequent part in the text was actually an item that tested “awareness of those principles.” If we were about to describe the item now, it would be deviating the intention of the item to explore awareness and it would not be possible at this moment to change the item of our questionnaire. The later part of the text had already self-described that those two principles are related to ethical considerations.
Reviewer Comment 7:
P3 ln111 The occupation designations need to be explained in more detail. The grades mentioned on ln 114 and 115 will be meaningless to readers who are not familiar with Malaysian practice.
Author’s Response:
We have added the following descriptions: The professional grades for clinicians are time-based. Entrance into public medical service starts from resident-ship (designated as Grade UD41 – we excluded this group as they were provisionally registered with the clinical service). After 2 years of successful resident-ship they become fully registered as junior clinicians with the designated Grade of UD44, and three years later, these clinicians are automatically promoted to Grade UD48. After 5 years of service in clinical practice, these clinicians are designated to Grade UD52, and nine years later they become Grade UD54. The time based service promotion ends here. They may be promoted further to higher speciality of Grades UD56, JUSA C, JUSA B and JUSA A based on service necessity, importance and higher level of administration as designated by the Public Service Department of Malaysia.
This description is added under sub-section 2.3.1 (demographics) part.
Reviewer Comment 8:
P3 ln119 Reviews is ambiguous as to whether it refers to book reviews or systematic reviews of a research field.
Author’s Response:
We agree with your comment here. To be consistent with response to Reviewer 1, Reviews here include systematic-reviews, meta-analysis, scoping reviews or rapid literature review. Book reviews were excluded. This description has been added.
Reviewer Comment 9:
P3 ln123 Why was this hospital chosen as the focus of this study? Is it typical of centres of this type in Malaysia, or does it have any special characteristics that might affect the results? Why were these two cut-off dates chosen? Given that we are now in 2020, is PubMed fast enough to have logged all the relevant work published in 2019? (I usually reckon that the standard databases can’t be relied on for a timely log of work published in the previous two years. So personally, I would have ruled out publications from 2018 and 2019 from the analysis.)
Author’s Response:
Dear reviewer, thank you for your query. Please allow me to respond to your query one by one:
- We have added the following description under section 2.1 (study sample and setting).
Apart from providing core patient care and speciality medical services, it is one of the most active prime sites for clinical trials and medical research in the Northern Region of Malaysia [16]. Medical research is mainly handled by clinicians, pharmacists and nurses through the established CRC within the hospital. Currently, there are 34 CRCs which forms a network across general public hospitals nationwide. These centers are maneuvered by the Institute of Clinical Research (ICR) housed at the NIH, the recent landmark for medical and healthcare research in Malaysia [5,6].
- The two cut-off dates were chosen as we wished to perform bibliometric analysis for the past 10 years. Moreover, it was the year 2009 when HSJ was forming to become an active research hospital.
- PUBMED deposits articles of abstracts as soon as possible upon publication by the journals. However, full text may vary from immediate availability up to 24 months based on the embargo policy of the journal. Details of PUBMED database are available in the following links:
PUBMED links further information:
- https://www.ncbi.nlm.nih.gov/pmc/about/submission-methods/
- https://www.ncbi.nlm.nih.gov/pmc/journals/
Reviewer Comment 10:
Does Hospital Seberang Jaya have any alternative designations?
Author’s Response:
None.
Reviewer Comment 11:
P3 ln126 Where do these five habits come from? What makes them interesting?
Author’s Response:
These habits are the most common items practiced while conducting research and publishing a paper. We need statistical packages to run analyses of data obtained and reference citation managers to cite references in text and to create bibliographies. Awareness of databases is important as these are key performance indexes set by institutions when authors publish a paper that measures the impact of the journals. Most commonly, authors look for journals indexed in PUBMED, Scopus or ISI. Awareness of ethics principles is the core in medical research - that is to do no harm while experimenting. Previous involvement in research anticipates that the clinician may have experienced and understood the process of research and publication well.
Reviewer Comment 12:
P4 ln138 how was the five point scale dichotomised?
Author’s Response:
We have modified the sentence and the subsequent ones to further describe the dichotomization. The current revision is as follow:
These domains were measured on a five point Likert scale ranging from 1 [least], 2 [less], 3 [neutral], 4 [great] and 5 [greatest]. Items were dichotomized into two categories: “least,” “less” and “neutral” as “lesser;” “great” and “greatest” as “greater” to ease interpretation.
Reviewer Comment 13:
P4 figure 1 This figure led me to expect a full Structural Equation model.
Author’s Response:
Dear reviewer, thank you for your comment. Actually, we did not intend to conduct a psychometric analysis or validate a scale for our questionnaire. Indeed, we did not aim to analyze the structural relationship between measured variables and latent constructs. The scales are assessing habits and factors associated with clinicians publication output. It would have deviated our study objectives or purpose of the main outcome measure if we were to conduct SEM. Indeed, the nature of the scale does not qualify for an SEM analysis.
However, we will justify the importance of Figure 1. As we intend to determine the best fit multivariable logistic regression model on what factors actually determines clinicians self-report publication output, we were limited by the argument posed by modern biostatisticians that are against to the somewhat “blind” method of variable selection into the model, and rather suggested to opt for a more “systematic” method of variable selection. Hence, we used the directed acyclic graphical method (DAG), plotted by DAGitty.
DAGitty is a browser-based environment for creating, editing, and analyzing causal diagrams (also known as directed acyclic graphs or causal Bayesian networks). The focus is on the use of causal diagrams for minimizing bias in empirical studies in epidemiology and other disciplines, so that we could determine items that have significant causal relationships and eliminate confounders at an early stage, through path diagrams (as shown in Figure 1). Details are available here: http://dagitty.net
We need to understand here, that while building a model, the multivariable analysis needs to explore two questions: whether the observed associations could be caused by confounding by participant characteristics, and what are the independent effects of the predictors. Building a model to test these is a task that should not be left to the computer or statistical software alone (conventionally we take all statistically significant variables at the univariate level to be pulled to the multivariate analysis), but the result of such analytic decisions should be made by the researcher through logical thinking. DAGitty helps in this regard, and figure 1 has showed that all items were correlated with the main outcome, no confounders were included.
Reviewer Comment 14:
P5 ln175 Is this figure of 234 a sample from a larger number of clinicians? If so, what criteria were used to reach 234?
Author’s Response:
No. The figure of 234 is actually all practicing clinicians attached to our hospital at the time of the study. In short, the questionnaire was administered to the whole clinicians’ population at our hospital (in other words, we used universal sampling technique). They were approached during their department CMEs, and all clinical and its allied departments were involved. As we involved the whole of “finite population” of clinicians in our hospital for analysis, the study was not required to have a sample size calculated. We made some modifications under section 2.1 (study sample and setting) lines 88-89. The penultimate line under this section had already explained where these clinicians were attached to and how they were approached.
Reviewer Comment 15:
p5 ln184 see previous comments on the Helsinki Declaration.
Author’s Response:
Our response is similar to previous comment. The Helsinki Declaration and Belmont Principles are the ethics and principle guidelines for conducting and reporting research findings that involve human subjects in medical research. Every clinician or healthcare worker who intend to conduct studies involving human subjects are required to undergo Good Clinical Practice certification which is a standard practice worldwide. They are exposed to the main pillars of Belmont Principles (respect for persons, beneficence and justice) and Helsinki Declaration (ethical principles of research in human subjects). Ln 98 is our ethics approval statement and we needed to report as such. The subsequent part in the text was actually an item that tested “awareness of those principles.” If we were about to describe the item now, it would be deviating the intention of the item to explore awareness and it would not be possible at this moment to change the item of our questionnaire. Ln 130 had already self-described that those two principles are related to ethical considerations.
Reviewer Comment 16:
P5 ln186. Does this mean that 16.9% of the 201 participants had a publication? If so, the effective group size is only about 35, and I’d guess that these people were mostly men.
Author’s Response:
It would be difficult to speculate and unfair to report publication output based on gender segregation here. Majority of respondents were women. The radar chart in figure 2 from the bibliometric analysis showed that the most prominent author is a woman.
Reviewer Comment 17:
P6 Table 1 “aware about major indexing databases” is a bit vague. Maybe some people who are aware of them have never actually consulted the databases?
Author’s Response:
The full statement of this item is “Aware about major indexing databases like PUBMED/Scopus/EBSCO, PsychInfo.” We had actually provided examples within the item. These databases do not actually provide consultations for authors, but they are databases that deposit published papers based on the respective journals of which are being indexed.
Reviewer Comment 18:
P6 ln 195 table 2 See previous comment about dichotomising the Likert scales. I don’t understand what this table is supposed to be telling me.
Author’s Response:
Table 2 explains the level of importance of journal selection metrics that clinicians would emphasize (either greater importance or lesser importance) when they wish to publish their paper into a preferred journal. It is part of the descriptive analysis of the results part. Results of this table have been described under section 3.3 (Clinicians Journal Selection Attributes). Dichotomization of Likert scales were described in previous comment and the text in those lines has been edited accordingly.
Reviewer Comment 19:
P7 ln197. 55 records is a tiny number of papers for a bibliometric analysis. It’s also small in relation to the number of clinicians in the cohort. It means that most participants had published nothing during the assessment period. Is this normal for a research centre of this kind? How does this figure compare with similar surveys in other fields? (Do Authors know about Lotka’s Law?)
Author’s Response:
Dear reviewer, thank you for your suggestions. Lotka’s law is interesting and we agree with you that it should be discussed in the paper. We have added a brief description, as follows under section 4.2 (findings from bibliometric analysis) in the discussion part:
The relatively low number of publication output among the large number of clinicians in our study sample had somewhat distorted the frequency distribution of scientific productivity curve as proposed by Lotka’s Law (Lotka, 1926). Lotka’s Law indicates an inverse relationship between the number of publications and the number of authors producing those publications. For all authors in a given field, the rule proposed that 60 percent of authors will have at least 1 publication, 15 percent will have at least two publications, 7 percent will have at least three publications and about 6 percent will have 10 publications. Our output generated far less than the output suggested by this law. Similar consistency was observed in a previous study (Adigwe, 2016). However, emerging literature has challenged this postulation on the applicability of Lotka’s Law to other fields, especially within the biomedical field (Adigwe, 2016). The relatively low number of publications among healthcare workers, for example clinicians in our sample, could be attributed to a number of factors influencing scientific productivity. This may include clinicians migrating or being posted to other hospitals or healthcare facilities, thus changing affiliations overtime. In addition, clinical practice is time-constraint and clinicians have limited dedicated time to be involved in medical publishing due to their commitment in patient care. Another limitation is that Lotka’s study focused specifically on first authors, hence medical related studies that require collaborative teams from different disciplines may deviate from Lotka’s assertions (Nwagwu, 2006; Nwagwu 2007; Adigwe, 2016).
New references have been added to the text and reference list:
- Lotka, A.J. (1926), “The frequency distribution of scientific productivity”, Journal of the Washington Academy of Sciences, Vol. 16, pp. 317-323.
- Ifeanyi Adigwe , (2016),"Lotka’s Law and productivity patterns of authors in biomedical science in Nigeria on HIV/AIDS", The Electronic Library, Vol. 34 Iss 5 pp. 789 – 807.
- Nwagwu, W.E. (2006), “A bibliometric analysis of productivity patterns of biomedical authors of Nigeria during 1967-2002”, Scientometrics, Vol. 9 No. 2, pp. 259-269.
- Nwagwu, W.E. (2007), “Patterns of authorship in the biomedical literature of Nigeria”, Library and Information Science Research Electronic Journal, Vol. 17 No. 1, available at: libres.curtin. edu.au/libres17n1/NwagwuPatterns_Final_rev.pdf (accessed 20 June 2014).
Reviewer Comment 20:
P7 ln198 See previous comment on reviews.
Author’s Response:
Our response is similar to the comment previously. To be consistent with response to Reviewer 1, Reviews here include systematic-reviews, meta-analysis, scoping reviews or rapid literature review. Book reviews were excluded. These are described between lines 128 and 129.
Reviewer Comment 21:
P7 ln203 The text needs to tell me why Authors think co-authorship is important.
Author’s Response:
Dear reviewer, ln 203 may be inappropriate to define co-authorship analysis and to describe their relevance. We have added the following descriptions in the discussion part under sub-section 4.2 (findings from the bibliometric analysis):
The evolving field of medicine and revolution of disease epidemiology has forced clinicians and healthcare workers to have wider collaborative scientific social networks for knowledge sharing. Co-authorship analysis is important to determine the social structure of the field being studied and how it relates to collaboration between authors and their affiliations (Koseoglu, 2016). It is the most tangible approach and well documented forms to explore scientific collaborations in terms of illustrating research teams, factors influencing co-authorships and impact-output metrics (Zupic and Cater, 2015). This study found that a total of 308 authors from 28 different collaborated clusters published 55 scientific papers from the co-authorship analysis. It would be wise to appreciate that this finding, which was consistent with a previous study within the medical field (Adigwe, 2016) has placed great importance on co-authorships collaborative efforts as the fundamentals to enhance research output quantity and quality across boundaries (regional, national, international or interdisciplinary boundaries) in the quest to yield new knowledge, innovations and discoveries in healthcare (Nwagwu, 2007; Adigwe, 2016).
The following references have been added:
- Mehmet Ali Koseoglu. Growth and structure of authorship and co-authorship network in the strategic management realm: Evidence from the Strategic Management Journal. BRQ Business Research Quarterly (2016) 19, 153-170.
- Zupic, I., Cater, T., 2015. Bibliometric methods in management andorganization. Organ. Res. Methods 18 (3), 429-472.
- Nwagwu, W.E. (2007), “Patterns of authorship in the biomedical literature of Nigeria”, Library and Information Science Research Electronic Journal, Vol. 17 No. 1, available at: libres.curtin. edu.au/libres17n1/NwagwuPatterns_Final_rev.pdf (accessed 20 June 2014).
- Ifeanyi Adigwe , (2016),"Lotka’s Law and productivity patterns of authors in biomedical science in Nigeria on HIV/AIDS", The Electronic Library, Vol. 34 Iss 5 pp. 789 – 807.
Reviewer Comment 22:
P7 ln207 The two most productive authors in this figure are also authors of the paper. Is there an agenda here?
Author’s Response:
The author’s declare no conflict of interests. This is unavoidable. Radar chart from bibliometric analysis will definitely capture authors somewhere into the figure. If we do not wish to have names of authors to appear in the radar chart, those authors should not have published any papers!
Reviewer Comment 23:
To publish 14 papers over a 10 year period is not actually a large number. Is this typical of medical research in Malaysia? (I also wondered if the choice of source journals ruled out papers that were not published in English?)
Author’s Response:
Dear reviewer, your comment here is somewhat inconsistent with comment no. 19. The total publications were 55 and not 14. PUBMED deposits all articles regardless of language. However, the top medical journals in Malaysia as described earlier are all published in English.
Reviewer Comment 24:
The names will be unfamiliar to most readers.
Author’s Response:
Thank you for your comment. Yes, of course the names would be unfamiliar. It is because the focus of the study in which the population involved here were clinicians in medical field and not academics. These clinicians are doctors who practice within their medical speciality or subject matter expertise fields; eg. surgeons, physicians, pediatricians, orthopedics, emergency medicine physicians, etc. They are clinically oriented who conduct research within their specialties. We hope to see these clinicians as legends of clinician-scientists in the near future!
Reviewer Comment 25:
P8 ln217 How should I interpret these data? Do they reflect the relative strengths of research groups in the Hospital, for example?
Author’s Response:
The following description was added to the footnote of figure (3):
Size of the nodes and words represent weights; the bigger the nodes and words, the larger the weights. Distance between two nodes reflects the strengths between them; a shorter distance means stronger relations. The line between two keywords means they have appeared together; the thicker the line, the higher the co-occurrences.
Reviewer Comment 26:
P9 ln224 This analysis was extremely difficult to follow. It might make more sense to do a structural equation analysis, and present the results in a graphic format.
Author’s Response:
Thank you for your comment. It is the most correct and accurate way to exhibit and explain our analysis that aimed to find factors associated with publication output. We reported the effect sizes (odds ratios and their 95% CIs) to explain how much likely or less likely a particular factor is associated with clinician’s publication output. Since our main outcome measure (dependent variable) and independent variables are categorical, we need to describe the associations using contingency tables as shown in our results table. Statistical significance was further described. Structural equation analysis would be harmful to our intended study objectives and deviates from our research question. We do not intend to perform psychometric analyses or validate a scale in our questionnaire.
Reviewer Comment 27:
P11 Table 6 what does Ref refer to?
Author’s Response:
‘Ref’ means reference category yielded in our final regression model. We have added another footnote below the table to explain this abbreviation.
Reviewer Comment 28:
P11 ln264 The text needs to explain why it is useful/interesting to compare consultants in Malaysia with students in Columbia.
Author’s Response:
The following sentence was added:
The relatively higher publication output amongst medical students could be attributed to the fact that medical students were still being affiliated within the medical academic institutions, thus escalating their chances to being involved in research and scientific publication activities with their supervisors or academic professors.
Reviewer Comment 29:
P12 ln286 This claim needs a proper source.
Author’s Response:
Reference no. [26] and [27] were added.
Reviewer Comment 30:
P12 ln300 The “Matthew effect” isn’t a theory.
Author’s Response:
Thank you. We have deleted the word “theory.”
Reviewer Comment 31:
P12 ln304 An example might help
Author’s Response:
The following description has been added as an example:
This could be observed when junior clinicians or residents are supervised by senior clinicians within their subject matter clinical expertise to execute research projects and reporting of study findings, a phenomenon similarly observed within the academic-student relationships during postgraduate studies at tertiary institutions.
Reviewer Comment 32:
p12 ln316 See previous comment about the Columbian medical students.
Author’s Response:
Our response is similar to the response on comment no. 28. Relevant descriptions have been added.
Reviewer Comment 33:
P12 ln324 It is indeed a novel finding, but Authors need to show why it is important rather than just curious.
Author’s Response:
Dear reviewer, the subsequent lines until the end of the paragraph had actually described the plausibility on such findings to emerge.
Reviewer Comment 34:
P13 ln338 The text needs to explain why the Berlin conference is important.
Author’s Response:
We have added the following descriptions:
The Berlin conference marked the declaration of championing open access publishing models to make scientific knowledge freely available. It was a point to transform traditional subscription-based publishing system to make articles freely open without restrictions to readers and the scientific community. The OA2020, a transformative agenda to accelerate newer approaches of publishing system was catalyzed, with the crafting of newer standard policies to which authors’ payments and cash flow to the journals were organized. The publishing and financial models were intended to be unified in such a way so that the switch would be feasible to be executed across the scientific community [38].
Reviewer Comment 35:
P13 ln350 This analysis needs to appear closer to figure 2.
Author’s Response:
Dear reviewer, this part was discussing the findings from our bibliometric analysis. It included the reported findings, consistencies and plausibility. The main results have been reported and described under sub-section 3.4 in the results part respectively. In addition, this part has now been further extended with descriptions and justifications to address your comments no 19 and 21 respectively as above.
Reviewer Comment 36:
p14 ln380 What kind of testable hypotheses do Authors have in mind?
Author’s Response:
Our subsequent lines until the end of the paragraph have described this.
Thank you very much for your comments and suggestions again. We hope that you would be satisfied with our revised paper and responses to your comments. If there are any further revisions required, we will be happy to address them.
Reviewer 3 Report
I congratulate the authors on a well-written and readable paper.
Do not repeat words from title as "keywords"
Author Response
Reviewer Comment:
I congratulate the authors on a well-written and readable paper.
Do not repeat words from title as "keywords"
Author’s Response:
Dear reviewer, thank you very much for your encouragement and suggestions to further improve the paper. We agree with your comments. We have deleted repeated keywords from the title words. We have added 1 new keyword as suggested by reviewer 1 that is the country “Malaysia.” We truly appreciate your efforts in editing the words, grammar and language throughout the manuscript as suggested in the pdf attachment. We have rectified all errors identified.
Thank you again!
