PubMed fever: A disease sweeping medical students?

Dear Sir

We read with great interest the article by Dyrbye et al. (2011) discussing distress experienced by medical students. The authors demonstrate that burnout is the most prevalent distress factor, with a strong association with quitting medical studies and even suicidal ideation. Surprisingly, we noted that the authors did not make reference to the immense demand to publish that now exists; as such, we believe a brief discourse is pertinent.

For medical students, the pressure to publish in an indexed journal is continually rising and potentially contributes to study-related stress and burnout incidence. The significant anxiety and preoccupation in medical students who are desperate to publish has resulted in the coining of a new term for the phenomenon – ‘PubMed fever’. The phrase aptly encompasses the ‘contagious’ nature of publication-related stress; student discussions often generate further anguish as competitiveness levels are revealed. Ever increasing job competition and earlier career decisions have made it necessary for students to bolster their curriculum vitae with publications, during medical school. We perceive numerous advantages and disadvantages of this situation.

Although barriers exist, such as a paucity of opportunity or individual motivation, there are ostensible benefits from early medical student involvement in academia (Mabvuure 2012). Active students can attain experience in the rigorous process of research and heighten their understanding of evidence-based medicine. Unfortunately, research demands significant time-investment and may require repeated attempts to achieve the goal of publication. Additionally, the element of chance is huge, especially regarding how publishable results may be. After diligent and hard work, students may face rejection and if not adequately supported, feel futile and disappointed. Hearing others reporting publication success exacerbates anxiety and generates inter-peer conflict, fuelled by the worry that future job attainment depends upon the number PubMed listings an applicant possesses. Lastly, student research may become ‘research for research's sake’ – with lower scientific quality and premature submission to journals.

Academia is an integral part of medicine and publications will continue to act as discriminating factors in competitive environments. However, we feel it is essential that medical schools strive to alleviate aspects of PubMed fever and that students should be supported and guided through their formative publication experiences. For example, the process of publishing should be explained at an earlier stage, and academic tutors should be encouraged to positively engage with their tutees over the concept. This will help produce academically active clinicians who are also, crucially, happy and content.