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Hello and welcome to the NRC M 2020. We are pleased to present our second webinar. Ask the editors. This is an opportunity to ask the editors of some of the most imminent medical journals your questions. So please do get stuck in and ask your questions using the chat function chair for this evening. Professor David Beard David has been a long time supporter of the NRC EM over the years he is a professor of musculoskeletal and surgical science is at the know Feel Department of Orthopedics Rheumatology on Moscow School It'll scientists in the University of Oxford. He is also director of the Royal College of Surgeons Surgical Intervention Trials Unit. His research interests include surgical trial methodology, including a placebo control designs outcome measurement on a variety of musculoskeletal intervention studies over to you, Professor Beard. Many thanks for, um, that's great. So first of all, just to say that I'm a I'm a huge fan and supporter of the national collaborative, and you've done some great work over years and hope it continues. It's the future of surgery for me on dissection that we've got today. This webinar is going to be really exciting I've seen some of the questions I know the speakers on D. I think it's gonna be a really excellent session. Um, just in terms of what the content is. So we've got publication, and it's really the currency of academic institutions. And they used to say, You have to publish or die. I think that's a bit extreme, but maybe publish or will it away on To get your research into these journals? It needs to go before editors and the editors. They do an awful lot of hard work. I think we are assume otherwise sometimes. But they're working very hard behind the scenes, and it's a highly responsible job. It's the end game off on enormous amount of funding, so lots of funding goes in. Lots of research done on day are the people who are responsible for getting it out into the public domain and disseminating so their responsibility to get that all research a fair hearing. It's important that the receptor right research gets out there on the right manuscript, get published on the wrong ones, don't get published or don't get get get, get them a fair hearing if it's if it's incorrect and not appropriate. We're not going to contribute to our knowledge base. So with that background, we've got four excellent speakers today with really good pedigrees, high grade editors from very good journals. And then we will bear in mind that the the audience of trainees predominantly so maybe some of the questions will be will be directed around those lines as well. On the four speakers, we've got our options. Cliff is representing and talking to us is the editor of the British journal Surgery. There's with Loader from the British medical journal BMJ. Just me Bagnall from The Lancet on Dmard on Sunday from also from the British Journal of Surgery. And they're going to speak to us for about five minutes each about their career. Have they got to where they were today? Maybe a little bit of insight, and then after that, we've got a whole raft of questions to go through, which I've been sent prior to this session on. Then also, we hope we get some good questions from you. The audience is well, so without further ado, I think we'll start off with Rob Professor Rob Pinch Cliff, if we may, just to introduce rob my new rubber little while Now it's legal yet three RCs on interactions there, but he's an editor for the British General Surgery is professor of vascular surgery at the University of Bristol, um on the Linda Foundation and the Rule College of Surgeons. He's the Linda Foundation Roll College of Surgeons professor of Clinical Trials, one of the new chairs, which exists through the RCs. There's an artery consultant vascular surgeon in Bristol Bath on the western area so down in the Southwest and has research interests on diabetes related to complications of the lower limb. He also involved in minimally invasive vascular surgeon, the development off the new technologies and surgery on their application to drive evidence based practice. The patients with vascular disease so a really good setting and backdrop to being an editor of one of the top journals in the country. Thank you very much, Robert, and I'll hand over to you on Thanks, David. And thanks to the NRC and team, I think this is a great insight. Hopefully for you a z, a potential publisher within be just some of the surgical and other journals. My journey really to become a surgical deter in many ways. A Zejula any of apprenticeship. Eso I started a swells. Then a surgical house officer progressed through to become eventually a research for that. That time my professor used to often discuss research papers that you use either submitting what was actually sent for review. Um, I remember the first, a paper that I was invited to make a comment on was one he being sent to the British old surgery. And some of you may know the title, but he was quite infamous. Paper. It was called endovascular aneurysm repair a failed experiment on from that sort of inside. Really, we started to discuss papers in between cases. So he was already sent papers to review from Mrs Jones Surgery would often discussing between the operating cases on that sort of wetting my appetite. And as I started to write my own papers, a junior author on he started security them. I started to realize that there was a lot more Teo publishing the night. Then I sort of realized I then I had the opportunity to you start Teo, review some papers on my own as I started to publish or myself eventually on opportunity became available. The Be just wanted to develop the next generation of surgical editors on became an editor assistance on really under the auspices of the more senior editors, I was given some teaching on how to review papers more substantially, to pretty them. I was involved in a lot. The editorial meetings had to, um, to take unedited assistant project. And from there after period of time, I became a junior, is so and then obviously on to more senior, it's within Be just really was. This was a surgical imprint is shit if you like in It's sort of, um, most. Most of basic sense on Digest sort of went up through the ranks as I was experienced. More more surgical publishing. Yeah, that's great. Think excited. So much for that. But it's also nice to see that rarely you're in the minority tonight with our panel. It's nice to see that we're going to move on next to our second speaker and guest on That's Professor Elizabeth Lodha, and she is head of research for the British Medical Journal, as we've said, and she divides her time between the three mg a day which I suspect is quite demanding on her positions. The chief of the division of Headache in the Department of Neurology at Brigham and Women's Hospital in Boston, she's professor of neurology at Harvard Medical School and his former president of the American Headache Society. And Problem has devoted much of a recent career to the development, implementation and dissemination of standards for research reporting. So the standard is really important in this area. I welcome you, Elizabeth, to give us a little worried about yourself. Well, thank you so much, Professor Beard and hello, everybody. I will preface my recitation about my journey to becoming an editor by saying that, um, it is not a journey that began with this destination in mind, and I did not set out with the idea that I wanted to become a medical journal editor. But now that I'm here, it seems that all of the experiences I collect along the way have turned out to be very helpful in my job is the head of research for the BMJ, and I guess the lesson which I'll draw before even tell you about my career, which has impressed me when I think back over my journey but also look at the journey's of other people who have really interesting jobs where you know one looks and thinks, well, Gosh, what a wonderful job. I wonder how how they ended up there. I guess the lesson I draw is that many people, if not most people who have really interesting, unusual jobs, probably didn't really set out with that particular job in mind. And they ended up there partly through luck, I think, but also being able and willing to see opportunities and and lucky breaks when they came along and to take advantage of them and work hard. So I trained in internal medicine and had no intentional idea that I might become an academic or a medical journal editor. Um, so I worked in general Internal Medicine, trained there and then worked immediately after I finished in a specialty headache clinic, which was a very unusual thing at the time. There were not a lot of specialty headache clinics. The one at the hospital where I trained had been started by general medical doctors, not ah, the neurologists at the hospital, which also was unusual. Um, so I entered practice. I had a lot of headache patients, mostly people who had migraine and other serious headache disorders. And we didn't have a lot of treatments at the time, and there were companies that were developing new drugs. Perhaps you have now heard of the TRIPTAN is they're actually quite old now, but they were developing those drugs at the time, and they needed places to do clinical trials, and they needed access to people with headache disorders. Um, and I had no experience with clinical trials, but I was approached by one of these companies and subsequently several more, um, asking if I would be interested in being a principal investigator in these clinical trials and they offered to train me and teach me how to run clinical trials. I think that sort of opportunity nowadays would be unusual. So I did a lot of the early clinical trials testing the triptan is, and I became very interested in clinical trial design. It was fascinating to me to go to the study conclusion meetings where the data were discussed. I became unauthorized a number of papers, and it interested me not only in the design of research but also the dissemination of research the way in which Spin could enter the equation, and I went back and got my masters in public health. I also became an assistant editor for some of the sub specialty journals at that time the journal Headache and the journal Cephalalgia. So I had some editorial experience. In addition to my experience is a clinical trial investigator in an author, and at the same time I was progressing in my academic career within the Harvard system. Um, I had always loved medical journals. I always had a stack of them by my bedside, Um, The Lancet, the New England Journal JAMA. I had read them actually since college, and when the headmaster of the house I lived in at college would leave his Journal of the American Medical Association line around. So I was always fascinated with them, and I always read the job ads in the back. But I wasn't really mobile because of my husband's job. And one day in the back of the New England Journal, I read a job. Add that sounded like it had been written for me. Saying that the British medical Journal was looking for a US based research editor who had some experience with clinical trials and perhaps had some editorial experience and that it would be fine for that person to work virtually and to combine their editorial work with academic or clinical work. So I started working for the BMJ and have never looked back since then. I worked as a general research editor for six years, learned the ropes, and then my boss, Doctor Trish, grows from whom I learned a huge amount retired, and I was asked to take over her post. So I now supervise a far flung international team of research editors, along with the team of statisticians who come through the many papers that are submitted. Select those that will be sent for review and decide among those with good reviews which ones we will publish. So there you have it on Dad. You said Professor Beard. It is a job, um, with a tremendous amount of responsibility. And I have to say I feel lucky every day to be able to to do it and I take the responsibility is very seriously, as I think all editors do. That's wonderful. Thank you very much indeed. For left. Okay, um, let's move on and start The question is where your thinking and I think some of these small bibliography is. And discussion from the speakers may generate some ideas in your head. So please get down on the chat line when you you have a moment to do. So let's move on to a doctor. Jessamy bag. No, on Uh, just me, George the Lancet. We're going to the Lancet. Now a senior editor in 2018. Before that, she worked as a clinical editor for the BMJ. So she's worked for the BMJ as well. On in 2017 was appointed editor in chief of the BMJ. Open quality. She's trained as a general and a breast surgeon in the NHS and had one son awards the market which towards the clinical excellence on Drum, the Royal College of Surgeons of England so good clinician to boot as well. So thank you very much yesterday. Be nice to hear from you higher there. Thank you for having me. And thanks to the other speakers, I would just echo Elizabeths words really in that I never really meant to end up unedited at the Lancet particularly. I did my clinical training in London in Northwest tens on. Then I did a fellowship with the back of your medical leadership management and ended up working at the BMJ is an editorial registrar for a year which showed was a wonderful experience and I learned a lot from Elizabeth, um on Dalser got some exposure to sort of help carry more executive level, became very interested in health policy, health, economics, but also the generation of scientific knowledge and how we, as a medical community in a scientific community, come to certain conclusions whether they beach, true or not necessarily, and how the research ecosystem moves towards those conclusions and the role of journals and editors within that sort of movement on. So after one being at the BMJ, I then carried on for a little bit doing some freelance with then, while I was also doing clinical practice and then to calm this roller as an Italian chief of that of one of their open journals on wedding wasn't sort of meeting to leave clinical practice. It all but got offered this job but the lancets and it seemed like a very exciting virginity. My interested kind of bored and two is I say, you know, health policy and economics and global health, which is a real focus of The Lancet. So I moved here in 2019. I find extremely intellectually stimulating, and it is a really, you know, extreme privilege to be able to work in that that space on, I work up this research and I want to do education on at a lot of things. We want to do a big commission. So we're quite sort of campaigning as a journal in that we try to take on topics that we feel need some sense of extra effort on that by joining people together and and Pat's trying to bring the numbers of the scientific and medical community together that may not always being together on bats comes them time to generates in new thoughts. Um, so I've been there for two years now, and I find it extremely enjoyable, and I'm looking forward to a discussion Join. It's great, thank you. Im adjust me. That's really helpful as well, so we'll come back to you shortly. And then, lastly, but not least, a Tall is Professor Malaise, and she's an editor of the British Journal of Surgery. Also on a professor of surgery. I never pronounce his credit, but the mere in Sweden apologize for that. But she Sweden first, perfect last, this female professor of surgery, which I'm surprised that to be honest with you, I thought that Sweden was more progressive than that on her clinical work books on breast surgery. And her main research interests are tumor stroma matrix biology and cancer by, um, Marcus on a quick overview from you as well, if we can thank you. And I think you pronounce it quite well, actually. So it's, um Oh, hello, everybody. And and thank you for the opportunity to be invited to this event. So I think a lot off. Ah, the things around my journey are similar to what you already heard. So I did not plan out to become an editor either. But the the opportunity came. So my background is such that I started out in basic science quite early during medical training and did a MD PhD and then, after that, went to Boston for a post. Doc and I was very much into the research career and pushing my papers to the editors have if you want to put it like that way on and off course, reviewing more and more also and becoming more interested in what happens on the other side. Um, I then came back to Sweden and started my surgical training and and, um, at some stage one off the senior professors in Sweden contacted me and said that he just has this editorial assistant bursaries that maybe you should apply. This would be something that you and maybe would like and actually applied, and I got the position the same year. It's Rob. There's usually two off those editor assistance that worked with the team for a year on. I did a project on What's the fate off the experimental papers in a clinical journal. And it was a fun year, and after the year was gone, I missed being in that group. So when the editor in chief, So I got back to me a couple of years after that and asked if I want to try out assay so see it editor than I off course I d. S. Then that's the road I'm on still and a few years after that became full editor, and I really like working in that group. It's Ah very international group. And we used to meet quite frequently now because off the pandemic it seems like years ago since we met last time. We have our meetings virtually now and then. I think what I find most, uh, fascinating is the discussions that we have around papers. And I think that, but really suffers a bit from not meeting in real life if say so. But so that's That's my journey to becoming an editor. And of course, uh, I struggle a bit more, maybe, than many off the other speakers years, because English is not my first language. So but in the big just editorial group, there's plenty of those that do not have English at s. There's first language. So So we Sometimes we're accused off speaking your talks, so I apologize. I know. That's why you're here tonight. I would ask him to speak Swedish. Crashing? No, thank you very much. Indeed, Mallon. Okay, that's great. So we've have good, good introductions and, uh, and some insight from your speakers. Now, his questions coming in and I got some previously I'm gonna start by. Everybody's interested in your career is a little bit to begin with him about things. So just just gonna give you a raft of questions just to remember them, and we'll go around the group if we May one from May. I just wonder whether you will love literature and English language. And one of the motivations is because you like the written word. Surely that has to come in to be interested in any of you. Actually, don't enjoy that. The person. The second question that we've got there is one Stephen Chaplain. They're online and he says, How do you balance the genital side with the editorial test that you got the editorial responsibilities? Because you're doing this juggling all the time. That's a pretty tricky thing to do, especially when probably busy on both sides. How did you manage that on then? Just in embedded in that if you just say quickly as well other. Any tricks of the trade or habits which you adapted were adopted over the year or help you with that. So 33 quick responses will go to rob first. It's about Do you like the English words Balance improved clinically with the editorial sponsor Bill. It ease on any tricks of the weight that you use on? Yeah, I think I think you do your daily. I think I enjoy the fish language. I think it's all part of communication on Do, um, you know, it's all about so writing a short letter rather than a long letter. It's It's all about trying to get the message across in a in a certain ST but clear fashion. I enjoy trying to do that. I think that's what surgical editing and editing is. That's That's a key key components of that in terms of balancing the clinical. In editorial worth of the 2nd and 3rd questions go hand in hand. Really, I think it's all about efficiency. I think, as you get older, the learn how to become more efficient to use your time more productively on. But, yeah, that's a key. The key issue from my perspective. That's great. Yes, I've always loved language. I was always, ah, great reader, and I think it is very helpful as an editor if one is prepared, Um, there has been prepared by reading to right. Well, I think it's really an essential quality. Not everyone, um, is equally as good and we certainly have editors who's first language is not English. But I do think that a facility with language help helps an editor tremendously, even an editor of a scientific journal. Wonderful, very much rough If we were going to just me, please toe and the same question, Yeah, I've always loved literature on the English language. We do a lot of writing The Lancet on, but I think it's a necessary part of how we communicate with in the medical community. And I think it's, um it's that it's only wonderful part to be able to, you know, disseminate your message across and somewhere where you can have really impact in terms of the nickel and a little really duties. When I was a balancing them when I was at the BMJ, it was very hard on. But I think it was all about compartmentalization to me on having sort of strict time zones to do things. I don't do that. Let the last six. I don't have clinical practice anymore. Maybe because the knots it mainly only have professional litters who don't do clinical practice alongside. I'm not sure how that developed, but it's a sort of slightly little historical practice that they have. So I gave it chemical practice when I joined the last one. Thanks. I'm Lesley Melon. Just in your Yeah, well, I I also I'm a big reader, and I always have bean reading a lot and not only in English, also in Swedish and finish s Oh, I love language and writing so that I agree that helps a lot. I think there's one more part to the balancing act. It's not only clinical practice and the Editori editorial part. It's also your own research because I try to do that as well. So I say it's three different things that I need to juggle, and it's Ah, it's all about trying to be stringent with your time and and focus on what you do. I think so and try to have not sleep too much, right? So you all seem to be doing a really good job with that Anyway, Now we're gonna get into the review process a little bit. Now there's lots of questions about reviewers and the review process. Some bit conceptual will come into that in a little while, and one question I have in front of you try to think about doing and that just yet. But is the peer review process broken? So we'll leave that just hang it on the sides. But in terms off revisions, I'm deciding whether to accept or something. When something comes in on, you get really done Version opinions from from reviewers. How how do you deal with that? How do you decide who you believe? I I know this process is in some journals where you go to a third rib here, but it doesn't always clear it up. Um, let's just go down very quickly on that rope. How did you deal with that? When this very divergent views going on, I I tend to have iron three reviews anyway. The gecko on Go often will have more than 22 reviews to go on the use occasionally find that you get so two on one side of the fence and one on the other. But actually, more often than not, you find that most people tend to be in the same direction. But I think clearly you know if if if you don't, if you feel there's a great diversion, so your views and that's the advantage of working very closely with inhibitory Ultram. So I will often, you know, past past papers, through mail, in or through other editors. Um, and we'll have a discussion about it. So it's all for this or for discussion, but often a say what you find is that you get most. Most reviews will sort of go in the same directions pretty unusual when you get really quite divergent views coming, Elizabeth, I think dr to them Yeah, I mean, I think this is a really good question, and I would say that the role of the reviewer and the power that reviewers have to either sink or champion of paper really differs, depending on which journal you're talking about. So it's small sub specialty journals. The editors may, ah, depend a lot on the reviewers at larger journals like the BMJ. We definitely take reviewers opinions into account, but the final decision is made by the editors, and I think it's a mistake in most cases to think that a single review, um, made a huge difference in terms of a paper. We look at the balance of opinion, but then we also have a large group of editors and statisticians who look at a paper very critically. And we sometimes reject papers that have wonderful reviews and sometimes take papers that don't have very good reviews. So I think it really depends on the situation the journals in and the resources they can bring to bear just me and, you know, on that. And I'm right, bring it just naturally. Naturally, Blanket brought in a question on here as well to say, How have you How do you make sure that the reviews are of high quality, the high quality standards that you expect, maybe just nice to get you? Um, Alan's opinion matters? Well, yeah, I would just quickly say so at The Lancet. All of our papers, a reviewed by three clinical reviewers and one statistician and all papers are disgusted least twice in the large meeting of all about professional urges, you will have either a chemical or scientific background where before sending out of paper, we actually look at the paper critically and decide whether we will send it out because we don't want to wait, starve us time like sending out things that we don't think we're going to make it on then afterwards, once they thought the reviews. Then again, it's discussed within a meeting with all of the editors and all of our associate it sister journal editors. Those meetings happened on a Tuesday and a Thursday, and they're open. So if anybody would ever like to join those meetings and please contact me and I can arrange that it's a normal an extremely interesting and sort of informative discussion and and shows you about the peer review process, and I would have to agree with Elizabeth. But I think that, um, you know, part of the role of an editor is to being aware of the different fields that you're working in. And so you make it, er, you may get a paper that is on Earth fell polarizing topic, and therefore you have to be aware of the people within that topic who are likely to be pro it or against a a classic example Michael statins or mask wearing now, um, at so you would try on get reviewers who would probably give you both sides of the table on then, along with other editors, you'd have to sort of critically appraise whether actually you know, that what the reviews were saying more out of this sort of pota rising instead of text or whether they're actually out. Fact of what that adds to this of scientific evidence at the moment. Is it Is it the end of story, or is it sort of? Mid story is there's all of a conversations that good one. So the peer review at themselves, you know that they're important and they often provide some very, very useful insights. But but I don't think they're sort of deal breaker, and we'll also often reject things that might have great reviews. But ultimately, we don't think that they're the right fit for The Lancet, for, you know, a variety of reasons in terms of making sure that peanut reviewers are good quality again, that's part of I think they're sort of responsibility of an editor keeping up to date with, you know, different people with in your field who's leading certain research. Attending a conference is, you know, networking within different fields and specialties to make sure that you know where that research is going, where the scientific community is headed so that you know who to review and who to invite and and much of being in other serious about building relationships. Whether that's, you know, commissioning things and trying to guide pieces of work in into a certain direction or negotiating whether positive trial ends up being a negative trial. Because, you know, one way it's fun. So that would be my answer. That's great. Thanks. And you can add to that. By all means. I don't want to stop that, but just just adding to the old your thought processes. Well, any training I know rubs cover off to be just a little bit, But maybe think about any training you off of that for reviews. Well, I would like to say that you you build your own group of reviewers also over the year. So, um, first of all, we work with sub specialty topic, so you tend to know your own field, and then you have tend to start working with some reviewers that are doing really a good job and on reviewing, and you're being the relationship with them. Um, and the off course, we as be just gives a lot of workshops on how to be how to review a paper and try to train new reviewers. And and then I tend to also try to invite new young reviewers that maybe aren't that known in the field, but that I know do good work. And sometimes I find that some of these reviewers are really good in reviewing. And then I tend to invite immigrants. I guess that's how you become trained. Indirectly. You have reviewers friendly. Once you mean this, bites will come to bias in a big bias is really important in this world is you'll be very aware and it's It's a bit unseen sometimes, but the will be bias is there, and trying to protect against it as a deters must be quite difficult sometimes. But you will probably want to go to certain reviewed's who, you know, do a good job or, I don't know. They just speak your language. It's that sort of affinity bias, which exists a little bit. And now the single said that you know, of course, you tend to also know what field, but people work on about the research interest are so they really know the field when it starts to be on the fringes of what's your field? So then it's good to work with those kind of researchers that have bean working in the same thing as reviewers also. Okay, that's that's good. Now I'm gonna go to sort of individually a bit. Now, we've got several questions that we need to get through. So if you want to ask, uh to answer a question, just probably hang up by all means. So first one, I'm gonna actually this one is specifically for Elizabeth. And the question is, in the two thousands of BMJ issued a mission statement to become more readable on appeal to everyday condition. I'm modeling itself on Cosmopolitan. Three great way to see the lacy Marie. And these days, that's so important. But readability more gentle should take this approach to be sort of, I don't know, offset the need for impact factor with the readability and access to it. Well, I don't know if Cosmopolitan was the the only model there was, but certainly there was a conscious effort to make the BMJ more readable. I have to preface this by saying that, um before I worked for the BMJ or knew anything about the BMJ, I always found it among the more readable of medical journals. I always thought it was very clear. And, um, it it turns out that, you know, I think if you compare the styles of different journals, the BMJ, although it's a British journal, and Americans might think that the British would naturally be more stuffy, um, I think has always been written in a very down to earth and accessible way. Um, yes, there was a conscious effort to to improve the accessibility and perhaps the appeal, um, of the journal, while at the same time making sure that the content is scholarly and reliable. Um, I do think that more journals should try that. I don't think the two things are incompatible at all. And in fact, I would argue that you're more successful, perhaps at a helping people identify the main message and remember the main message of a paper. If it's written very clearly, um, and then effort is made to do so. Do you think it's improved over the years? Um, I do think it's improved over the years. Yes, Um, absolutely. I think the attempt to blend a scientific journal with a more journalistic and magazine type approach has been quite successful. Agree with that the danger there, I suppose is, is losing some of the technical detail and things. And sometimes you need technical detail. So it's It is a a big challenge, actually. But I do agree. I think it's improved well. That's where online appendices and the fact that you can put almost everything online now really help. No pendency is really important part of coming to you on this question here. What are the big well here? This You have a go to a conference where you go to a seminar. It's just this is how to get your paper published on. It's riddled with myths, which are the biggest myths that you've come across. Where these how to get your paper published myths? Or do you agree with the more when you hear about them, you probably got your own little pet laundry. I will go and you are actually, no. I think there's a supposition that just because you come from a well known institute for have published submitting a paper with a large end large numbers of patients that you will Timoptic get published in a reputable journals. I think on that's a miss, that we should debunking he's actively deep on a regular basis of the be just, uh, well, I guess the one thing that we don't like that much is this grandiose thought of this is the first paper ever. Um, you know of showing whatever because you don't know that it is a new problem. So that's one thing to try to lose from your paper? Yes, to me, No myths debunking Mets are ones that you don't agree with when they say how to get your published. This is how you get your paper published. I suppose that there's any sort of formula, a total. I think it's, um it's probably grown. You know, Uh, I think the way that journals choose the papers is not a scientific process, and it's often about what's going on at the moment, you know? So at the moment, grace on ethnicity is, you know, a huge drive for many journals in trying to increase that sort of visibility Covert. 19 2. There are lots of topical things that go on that make a paper more or less suitable at a certain time, so I really don't think that there's any kind of formula that you can apply to guarantee publication because people are desperate for that, aren't they? And there's somebody the other side of the fence. We will write papers. Who wants think this is good? This is one of my best papers, and it gets thrown out or other ones. You think you can almost see arrows in your own sometimes, and they and they get through. And so I think probably it's difficult for people not to know there isn't that more it for real. And it's there is a level of judgement in it, and there is a level of serendipity on there is a level of contemporary. This is a whole bunch of Queens October input into the decision to accept the paper, particularly in the higher journals talking about. Exactly. And I think that's one of the existential crisis is that most editors from faces way with ourselves about these types of decisions. What's that? Yeah. Oh, echo. What? Just, um, he said, I don't think there is a formula. I like to think that extremely good important papers will always find a home in the BMJ and that really badly done. Poor papers will never find a home but for the papers that air in the middle. And that's most of them, um, they can be perfectly good and fall victim through no fault of the authors of the researchers two things such as a similar paper just published in another journal or other more timely papers having been submitted, those kinds of things happen all the time. I guess. One myth. I hear a lot, which I think is, um, really not true, at least not true. If we're submitting to the BMJ is, don't bother to write a cover letter nobody ever reads. It's true that sometimes we don't read them, But other times when we're really debating about a paper, I do look at the cover letter to see what's the elevator pitch here. Um, and I agree with malocclusion of precedence, and this is the first really don't do it for me. But something about why this is clinically important or why it should matter. Um really can't make the difference between us deciding to put the paper out for review versus rejecting it as we do up front with, you know, 85% of the paper submitted. Yeah, absolutely. And you must all come across the beautifully written paper with low content on the very poorly written paper. But actually, you think this is quite important thing. We have to deal with this somehow any any issues or any tips, Or I suppose you just take my merit and decide, You know, I think I think Go ahead, Go ahead, Robby up. I mean, I think they did. You get sort of three groups of articles or three groups of manuscripts, one of those absolutely stellar papers and you read them and you think where we, you know, whatever the review of saying, we're going to accept this and then you get the ones that are absolutely terrible. You think you know that there's no way that this is going to fly But most of our papers of mine included a somewhere in the middle, and they take a lot more 40 in some ways about Is there a clear message? Here come the editors. The reviews sort of a nerve. That message, and that's in some ways he take, is a bit more skill involving the editorship. Really, To try unpick the most important clinical message out of that improve it on. Do you really make it flying? I'm assuming it will not comment. There, there there is, um, it's improved. Your writing, maybe. Or your submission is well, by being editors, I suspect that your your quality of submissions for your own work and the work that you're involved, it's come up a swell. Let's go uses. Now we're going to move on to dissemination quickly. James, please, please got a question here on out dissemination. How much do you do to help with the dissemination so important? So we all know that you can write beautiful papers. It takes a long time to get there, and then nobody reads the damn thing on that. That's very unfortunate, so that the important thing is getting that out there. Do you have a focus on that in your journals on how do you help people who have published with that process? Let's go around a good sort of melon. Anything from Well, I I think Oh, I hope that some off the audience has seen what we try to do in BJs and and Rob can off course, and we try to off course, work through social media platforms and try to raise questions and interest in the papers through that, we also have tweet chats on interesting topics and papers that have come up. And, uh, we just initiated something called the Young Beaches, where we try to gather lot of trainees and a new, younger generation that can be involved in our papers and the discussions that I'm out of those, Uh, that's it. Least some things that we do. I don't know, Rob. You want to add something? Yeah. I mean, we have 30,000 followers on Twitter, for example. We have developed things like a linguist summaries to try to reach the patients of public audience. We have a a sort of residue gestational young, be just which is all about you developing the next generation of surgical researchers than improving networking education innovation percent. You're a review mentoring program, which is all really, really quite early stage, but quite well, quite excited about him. We've seen quite a lot of excitement, I think, from a young be just potentials. That's great. Thank you for coming to you on about a different question. Slightly change the subject. Really? So a lot of people like to go for pre submission enquiries. They kind of badge. You're not, you know, have it on LP or what do you like to hear from the result of this? Or do you prefer just to be a submission and stately? Um, we're always happy to answer pre submission enquiries. The more specific they are, the easier it is to give the authors theater vice that they may need. It's especially useful when the paper that they are asking about really isn't in scope for the journal. And then we are able to say, You know, sorry, this just is not the sort of thing we published. Maybe it's basic research, animal research. Maybe we just published something the other week on this, and we're going to be moving on to other topics, so I think that's useful. If people give a very vague description of the research, it's really hard to even opinion. And then we will screaming, Go ahead and and try to submit it, and we'll let you know quickly. We do try to make decisions about whether to send something out for review very quickly in order not to delay people sending it elsewhere. And we have a cascade system so that we can send it on if they choose to another journal among the BMJ family of journals. That's really helpful. Um, PJ s you have got to take that well, Melon or Rob? Well, I think it's okay. First thing I think it's okay because it's sometimes saves the author also some hassle to submit something that we are still not interested in. But of course I'm saying that with some caution, because I don't want a whole big load of those pre submissions. I think it's quite rare that the authors actually do that. It's more maybe meeting somebody at a conference, and they're asking whether this could be off interest. So in such a setting, more than actually sending ah, on abstract or something, just me lancet you might be with a question like Internet cut over there. That's okay. So we were just talking about pre submission inquiry. So you're busy enough. We've already know that you've got your desks full on, gets hard enough to make decisions, and then you get lots of free submission enquiries from from the other side of the fence again. Sometimes I could be really helpful because if you're given a bit of a steer. You might think your work is very good in that, and you might see straight away that it's not going to get very far. And it's better to turn that stage and roll and go down that line. But I can also see that if you get lots of those sorts of enquiries, you can't answer them. What, you have a policy? Yeah, well, we didn't We were very open to 37 missions. You know, at The Lancet. We really keen to build relationships with all of our authors, so we'd be that as part of our long on do, uh, we're very so there's enough information, but we often get back to you. There isn't enough information to try and find a nabs tract with something, and then do that one. We've lost you again, just me not to worry. Now let's see if we can bring it around a little bit to thinking about our audience and probably be a lot of trainees on on this with collaborative or wanting a big publication or wanting to get down that line. Any and ice mean it's probably not an editorial decision but anything about authorship sequence with those that can cause some problems. Um, people taking last place first place time when the work has been done. Do you have any advice for them in terms of trying to cut down the amount of research? Perhaps so generals reduce the volume, but the quality goes up. But then you don't get as much opportunity to publish almost a bit like time and theater. Anybody want to make any comments about the trainees and how they should view? Well, maybe I can start. I think authorship is something you should. This I don't want to start to write a paper. It's not something you do at the end of the process, because that's always going to lead, and that's from to fight. So er or ah, unhappy Ms I. I think it's important, and I speak as a researcher myself, trying to trying to always make up that to start with, because it's it's the cleanest way to do it. And of course, things can change during the process that might lead to some changes. But, um, and I must say that I'm really a huge fan off all this call abortive research that goes only there you can trying to push it also here in Sweden, because I think it's fantastic that young people get so much so involved in research. But it's also important to be involved in the writing part and not only in the collecting heart off the data, because you need to also train in in the writing part to become a real you know, author and training the authorship. And it takes a while as well. I mean, I think it doesn't. You can't get it over night. I don't think. Yeah, Rob going to comment on that stool? No, I think I shared my men to use that that I think the collaborative work read from trade. He's being fantastic. I want sort of notice. Caution. Of course, with the authorship comes responsibilities. And as we've seen through various high profile cases, notably in Sweden, Yeah, there there are. There are significant consequences if if you if you get it wrong, Great Elizabeth moving to you just in terms of tasks and the process. Now, a little bit question here from John Canavan's Hard to hit the final Submit button on. We'll know that time when you're doing formatting getting a little arrange, and there's so many rules from you guys of what you want and how you wanted it. How important is all of that? You do through things out. If it doesn't comport to what you want, you go write. Go to be a screening process. You've messed that up. I don't you go. There is a screening process. It's rare that we would reject something because it isn't for matter. It's missing this or that. Certainly, formatting really makes no difference to us unless it's so poorly formatted that it can't even be red. And believe me, we see papers like that where the figures air very poor. You cannot enlarged them to the point where you can read them. Those sorts of things obviously work against authors. The other thing that we really do need to know upfront we need a clear accounting of conflicts of interest and competing interests, and we also, in the case of clinical trials, really need the information about registration because we don't publish trials that have not been prospective. We registered beyond that were to some extent of victim of the manuscript handling system that we use where we can enforce collection of certain information on Li at certain points in the papers journey, we're still struggling with this. We would like in an ideal world to make it as easy as possible for papers to be submitted, sort of a come as you are policy. It's difficult than those to customize going back and obtaining the information that we don't have that reviewers need in order to review a paper. So we're still working on that were very aware that it's challenging for authors. I wish I could say that it's going to get easier soon, but I'm not so sure that's true. Okay. Jessamy used to with us. No, I can't hear you say that with a straight. I'm gonna There's a question here from Roa Tom are now. We'll just paraphrase a little bit. It comes down to sort of discrimination on some of the difficulties which are encountered bye countries and organizations and individuals and sometimes groups in getting research published. So there is a potential discrimination which goes on. I mean, do you ever have such a thing as a a truly blind review? How much do you try and compensate for Caucasian name. She's you the example, for instance, and things like that. I mean, assuming that all journals have a strong policies now to prevent that from happening. Let's just go around if we can. Starting with the Lancet just means that okay with you. Yeah, definitely. We have, um we have strong policies on this and ones that were strengthening, probably over the last six months. So if a paper from a global health or interviewed paid for is about a country, then we insist on some of those authors being from that country. So we wouldn't accept a paper that was written by Americans that might be on vaccination in Kenya. So that's one way that we try and combat that on when we were reviewing, we always insist on a local reviewer about, you know, to to give us context in terms of sort of further discrimination we have. We try and have some positive discrimination. So when we try, when we when we choose authors to right linked comments or limb told editorials, we try, we we have in our letters to encourage gender and geographic and ethnic diversity because we we believe that genuinely gives a better paper for the most part and a broader perspective on likewise, when we conditioning educational content commissions content, we we really take all of those things into account. Eso We have had to been campaigns on gender and ethnicity over last two years. To really make us think about those aspects of discrimination a lot more. That's really helpful. Thank you very much for that. Um and please, dear Elizabeth comma BMJ side. Yeah, we're very aware of this as a potential problem and I guess I would characterize a response to this. As as Jessamy said, We're examining all of our processes and thinking about how they could be changed. Right now, we depend on what I would call sunshine and an appeals process. So by sunshine, I mean, we have completely open review the reviewers air in known to the authors. Everything is above board so that if people feel hard done by, um, they know who who the reviewer was, and they are free to say to us, I think so and so reviewed my paper negatively because, you know, we've had this interaction before, or there's this kind of bias and we take that very seriously and often will send a paper out for additional review if authors do not feel the original review was fair. We also have an appeals process where if your paper is rejected and you think it's for unfair reasons, you are free to appeal. We try very hard to get reviewers who are diverse, geographically diverse, um, diverse in terms of gender and many other characteristics. It can be challenging. And and I will say we try to be careful, too, when we select editorialists. Um, I have had the experience many times of people who have been reviewers for a paper, volunteering and editorial, or even sending me an editorial that's been completed. And with very few exceptions, they have been men. Women rarely volunteer themselves. S so we we try to volunteer the women, even though they may not step forward with a fully written editorial. That's good. Js. I'm not sure you want to take this, or you can both have a comment of you A Z right? He said they did the names be jazz rather than British doing a surgery. Now we tried to move away from the British because really we still got a big European focus on the majority of our plan. Your scripts come from Europe, but increasingly we're seeing more more from but North America on China store Lady A so way are seeing more, more diversity there. I think I tried to work with always reviewers from any country from different countries just to get that justice, Rob said. I sent out the three reviewers and try to pick them from different countries just to get diversity in that sense. Now we're probably starting to think about wrapping up. I think so. Just a conceptual. Some big questions Now. I mean, is it right? Well, we're very. This group that we've got in front of us now is is a prestigious group from prestigious journals on the way to get on is to get your name in a prestigious big high impact journal. Is that system going to continue? Is that the right system? Or if there's something better, should we still have this high impact concept and to get into these very best journals to progress your career on to disseminate the best research? Probably, um, fair to ask you that because you're all part of it took around anyway. Just meet you out to start on that. But there's a great question on D uh, anybody that's interested, I would say that sort of required reading would be something called the Misinformation Age, which is a great book about the age that we live in. It's information within that on do. Certainly, that is something to consider. When we're thinking about the future of journals, what the future of journals are, I don't know. It's an interesting question, whether it's right, I also I'm not sure, um, it's the one that we haven't the moment on. For the most part, I think that larger journals will survive, but they will need to become much more campaigning and need to offer much more. I missed a question earlier about communication, but when we think about what a journal is in the future, communications, a key aspect of that our communication team is now probably 30 on Do how we are disseminating information and making sure that that information is factually correct on also available to the more sort of general audience will be one of the things that I think journals they judged on will be one of things that make gentle survive in the future. Um, whether researches should be able to get on if they get the papers in high impact journals. I don't think that that's necessarily right, and I think that that's changing. You know, we've got things like Clamminess welcome dress, you know, Bill Gates Foundation. Serious movements towards open access, which will shift the entire ecosystem of the way that journals work from of the over the next 10 years. And it it will be interesting to see how that spans out. Um, I think that's it will be. I hope that it will be more equitable. But I do think that there is a role for journals that add value on journals that offer interpretation on journals that offer campaigning. I agree, and I think the vehicle may change as well as we have become almost more media serving, maybe balancing those two things that may not be the journal, just how it delivers this message, and I go what the what, the previous speaker said. But all and in my country there's actually for public funding. You have to publish open access so everything needs to be open access anyhow in a few years. So right, Elizabeth, Final comments. Ah, yes. I think there will always be a roll of some kind for journals and that major journals will persist. I think that with the explosion of information and misinformation, people are very hungry for trusted experts to curate content. And I think the role of journals may shift from publishing the research because, of course, now you can publish your research on pre print servers and it's open access. I think they'll be judged mawr, um, and found useful because of the commentary and context and added value that they bring surrounding research. Thank you very much, finally wrote. Just to finish up. I think they're all very safe comments today that I don't have much driving in addition to that. But I think clearly is very rapidly changing time on. Girls have really got to convince everyone that they're providing added value. I think we do at the moment. But we were suddenly number of jobs out there that probably need to reflect on what I had a value there provided thank you very much. So I'm gonna pass over back to Lauren now, at eight o'clock were up. So when I just want things to speak it myself cause I really enjoyed that, I'm I'm reassured that state of a lot of publications are in very, very good hands on dong. May that continue. But you've been really generous with your insights and time and thought so. I'm sure the audience who are listening to this really appreciated as well. So thanks. Thanks very much indeed. Not possible to door in there. Thank you all so much for this. Excellent sessions. Been very insightful. Um, very interesting to hear from you'll and thank you again to our chair this evening. Be it on before we close the seminar.