Editing for Surgeons Specialization Among the Specialists News & Views Feature Article

by Thomas Leibrandt, Editorial Director of the Department of Surgery Abington Memorial Hospital (Abington, Pennsylvania) Originally published in News & Views January, 1997 issue. Copyright 1997 STC-Philadelphia Metro Chapter. For permission to reprint this article, contact the Managing Editor.

And now for something completely different. I'm the editor in the department of surgery of a teaching hospital. You're probably asking yourself the same question I did when I applied for the job: why would surgeons need an editor? Actually, several institutions have publications departments to assist their physicians in reporting the results of their research. The publications department at the Mayo Clinic, for example, has a staff of over twenty-five people, including editors and proofreaders. But the reason the department of surgery where I now work wanted an editor is rooted in the accreditation process of general surgery residency programs. Training general surgeons At present, there are 270 accredited training (residency) programs in general surgery in the United States. Collectively, they graduate about 1,000 general surgeons a year, a figure that has remained the same for the past fifteen years. Each general surgery residency program is at least five years in length. The accrediting body for general surgery training programs mandates that the majority of the teaching staff demonstrate "scholarly activity," which it defines as research projects, membership in surgical societies, presentations at national and regional scientific meetings, and publications in peer-reviewed scientific journals. One surgical educator described scholarly activity more simply as having only three components: "publications, publications, publications." Realistically, journal articles and chapters are the best way to quantify scholarly activity for the periodic accreditation reviews. Inadequate scholarly activity can contribute to a program being placed on probation or terminated and has remained the fourth most common citation against general surgery programs over the past four years. About two-thirds of the general surgery residents are trained at university programs (institutions that have a school of medicine). As members of academia, the teaching staff at such programs have inherent incentives to publish if they wish to be promoted. At non-university programs, however, teaching surgeons must balance busy private practices with the demands of producing scholarly activity. They need more assistance than their university colleagues. When a new chairman was appointed to the department of surgery at a local non-university program in 1984, the general surgery residency program was on probation. One of the major citations was, you guessed it, inadequate scholarly activity. I was hired initially to address that concern. Basic training Before answering an ad from the American Medical Writers Association announcing the position, I had spent five years in a publishing company editing scientific manuscripts for textbooks and journals. My experience as acquisitions editor, balancing several books in various stages of production, coordinating honoraria, and tracking down and cajoling authors and reviewers to meet deadlines, proved especially useful preparation for dealing with busy staff surgeons and elusive residents. And the author is… A common misconception is that departmental and institutional editors actually write the manuscripts and the physicians put their names on the papers as authors. I don't ghostwrite papers. My editorial services are available to any of our sixteen teaching staff surgeons or eighteen surgical residents-from the initial MedLine search, through planning the study, outlining the text, editing the text, preparing the illustrations, and reading page proofs, to acting as the author's advocate with journal and textbook editors. I insist, however, that the authors provide me with a manuscript. I get some on disk, I get some typed, I get some handwritten, I've even gotten a couple that resembled ransom notes. But once I have a manuscript, I can guide the authors in focusing or developing it. Writing papers for the staff is, I believe, a dangerous precedent to set. Working with surgeons Most people don't relish interacting with surgeons, and understandably so, because your time spent with a surgeon means you might need an operation. The surgeon's ego is legendary in the media, a mainstay from "St. Elsewhere" to "ER." It is not a myth. The making of a surgeon depends on gradually increasing responsibility, commensurate with technical and cognitive judgment and ability, and leads to the self confidence to make often difficult decisions in trying circumstances. I don't know about you, but I wouldn't let anyone cut me open who wasn't real sure of what he was doing. Ego is not an impediment if you can help improve the end product and save the surgeon some time. I have found that, as specialists, surgeons have little difficulty deferring to other specialists, and a scientific editor is a specialist in an area where many surgeons have little expertise. They are, believe it or not, usually very grateful for the assistance. Over the years, I have edited manuscripts in most of the medical specialties, and in my experience those written by surgeons are the easiest to edit. By training and disposition, they focus on what's important and what's relevant without getting lost in laboratory values, chemistry, or psychological jargon. When used properly, ego can be a useful tool in generating other projects. I circulate lists of recent staff publications regularly. The discovery that a fellow staff member and professional competitor has one-upped his colleagues by contributing to the surgical literature often leads to the following comment: "If what's-his-name can publish a paper, I can do it." "I'm sure you can," I reply. "What projects do you have in mind?" The pecking order So, where does the editor fit in a department of surgery? A colleague once likened the editor to the court jester. Traditional departments of surgery, he reasoned, are "feudal." Everyone reports to the king (chairman) and is, in turn reported to by underlings in a hierarchical system. Except for the editor. No one reports to him/her, and the editor's sole function is to keep the king happy. There's an element of truth in the analogy. The king is happy when you're doing your job well. Different strokes My approach to editing manuscripts from the teaching staff differs from those of the surgical residents. The teaching staff surgeons are extremely busy professionals who usually just want their manuscripts "fixed." I am a resource and colleague to them. My interaction with the residents has the added dimension of teacher. I use the editing of their manuscripts as an opportunity to instruct them in some of the principles of scientific writing. The resident and I review each editorial change on his/her manuscript. Several of our graduates have continued to write scientific manuscripts (without an editor's help) after they've left the program. Productive strategies Be versatile. Within my first two months on the job, I was given the additional title "educational coordinator" just before, in the next sentence, I received responsibility for several of the educational functions, such as coordinating the department's daily teaching conferences for the residents. When the institution eleven years ago proved less responsive than the chairman liked in producing slides for national and regional presentations, I became the audiovisual coordinator. Now, it's laptops and LCD projectors. Gradually, I took on responsibility for most of the educational resources of the residency program, in addition, of course, to editing manuscripts for publication. In today's economic climate, especially today's healthcare environment, versatility is a plus. Track the projects. Manuscripts originate from several sources. Chapters are always at the invitation of the book's editor, and two of our staff, nationally recognized surgeons, usually have a chapter or two in the works. Other teaching staff surgeons receive occasional requests to write chapters. Most of the manuscripts result from the inquisitive minds of the teaching staff and the residents. "Can you do a literature search for me?" often leads to a case report or retrospective review. After performing the search, I'll ask the surgeon which of the cited articles he/she wants and offer to obtain them from the hospital library (an offer that has never been refused). Updating my comprehensive list of work in progress is followed by periodic, low-key nudging. Be visible. The best time to interact with surgeons is early in the morning because 1) the operating room isn't open yet, 2) they're fresh, and 3) I can't emphasize this enough, the operating room isn't open yet. Being at work by 7 a.m. lets me attend meetings, check the teaching conferences, and, on occasion, have morning coffee with the teaching staff and residents. Advertise. After completing the general surgery residency program, almost 60% of our graduates take one- to two-year fellowships in such surgical specialties as cardiothoracic surgery, colon and rectal surgery, laparoendoscopic surgery, plastic and reconstructive surgery, surgical critical care, and surgical oncology. I make sure all our residents know early in their training that a professional bibliography facilitates obtaining these positions. I reinforce all the ways an editor can help them. Our mutually beneficial relationship often begins with my providing services in areas other than editing manuscripts, such as preparing curricula vitae and helping with correspondence. Be creative. Propose projects. Three staff surgeons and I came up with a novel approach for a book on surgical techniques. We asked expert surgeons to provide between fifteen and twenty practical ways ("tips") a practicing surgeon could use to improve the diagnosis, treatment, and follow-up of patients with specific surgical conditions. We wanted no references, bibliographies, overviews, historical discussions, or anatomic reviews. Rather, we stressed practical, cost-effective, and time-effective strategies that each author had accumulated over his/her career in caring for patients with that condition. The resulting book, Surgical Tips, was published by McGraw-Hill in 1989, and the three surgeons insisted that my name be listed on the cover as one of the editors. Results How have we fared? The program was off probation within a year, and we have undergone three other successful accreditation visits. Inadequate scholarly activity has never been cited again. After the last visit, we were accredited for the longest period possible (five years) with no citations or concerns. Colonies The advantages of an editor to surgeons have been presented at meetings of the Association for Surgical Education and the Association of Program Directors in Surgery and have been published in Current Surgery and Focus on Surgical Education. The opportunities for editors were described at two national meetings of the Council of Biology Editors. My chairman and I have received thirty inquiries from other departments of surgery, and at least four new positions were based directly on my job description. In each presentation and in response to each inquiry, we emphasized an editor is only one component in producing scholarly activity. An environment that fosters academic inquiry results from the synergistic relationship between the teaching staff, the surgical residents, and the editor. Last thought My job has another unusual benefit. The realization that I've played some part in the education of the young surgeons who graduate our program is very satisfying.

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Last updated: January 25, 1997 (rst)