https://orcid.org/0000-0002-6195-070X
Abstract
Purpose
Although health professions education (HPE) scholarship has flourished in recent decades, the influence of HPE journals has received little attention. This study examines the editorial policies and priorities of leading HPE journals.
Methods
Fourteen HPE journals with the highest impact factors were reviewed for their editorial aims, scope, intended readership, and priority topic areas. Text from journal websites was coded using thematic analysis.
Results
10/14 HPE journals included in this study were linked to regional or national education societies. Two focussed predominantly on medicine, one on dentistry, one on nursing, one on nutrition, and the remaining nine on general HPE. Although journals differed in their projected aims and proposed readerships, four overarching editorial themes were identified: (1) methodological and theoretical rigor; (2) impact on practice; (3) global relevance; (4) advancing knowledge.
Conclusions
Leading HPE journals share a number of priority areas and principles, implying some cohesion and consensus amongst the HPE scholarly community. These journals prioritise impact at the level of individual practitioners. Given the importance of policy level change in the development and reform of HPE around the world, the relative lack of focus on policy impact in HPE journals is worthy of further exploration.
Introduction
Healthcare professionals are increasingly required to work in complex and challenging environments with continued pressure to update their knowledge and skills (Braithwaite et al. Citation2020). There is longstanding recognition that policies and practices employed by healthcare professionals to solve these challenges should be underpinned by scientific research, evidence, and scholarship (Sackett Citation1997; Cookson Citation2005; Rotgans Citation2012). It is here that scientific journals have played a crucial role in the medical research and clinical communities, with their editorials setting the agenda and contributing to the subsequent debate. In addition to the editorials themselves, editorial policies at these journals may have a significant impact on the topics of articles that are accepted for publication, and as such the representation of editorial boards in scientific journals has been carefully scrutinised (Mazov and Gureev Citation2016).
Practice points
Leading journals in health professions education project a focus on methodological and theoretical rigor; impact on practice; global relevance; and advancing knowledge.
There is comparatively less focus on prioritising impact at a policy level in the stated aims and priorities of these journals.
As with biomedical scientific journals, the editorial policies of health professions education (HPE) journals may have significant influence over their ultimate impact. We are witnessing a global growth of HPE as a discipline. There are an increasing number of scientific journals founded in HPE, rising more than 10-fold in number over the last four decades (ten Cate Citation2021). These journals provide an authoritative platform for the dissemination of knowledge. Some of the longest established HPE journals, indeed, have been linked to medical societies, such as Medical Education with the Association for the Study of Medical Education, Medical Teacher with the Association for Medical Education in Europe, and Academic Medicine with The Association of American Medical Colleges. In addition to the establishment of such HPE journals, there has been an increasing shift towards professionalisation in HPE itself in recent years, with the development of established careers, roles, fellowships, and prizes, including the international Karolinska Institutet Prize for Medical Education.
With this evolution, there is an emphasis on the need for education-based policies and practices to be underpinned by scientific evidence (Wood and Bligh Citation2000; ten Cate Citation2021). Despite this, the research landscape for HPE remains largely unsupported from funding councils who have seen it as the ‘poor relation of medical research’ (Todres et al. Citation2007). There remain calls for an increase in methodological rigour and funding support for large-scale empirical research projects (Bligh and Brice Citation2008) to support the use of evidence-based practice and policies in HPE. Despite the great potential for HPE journals to aid this transformation, it is not clear how exactly this occurs at present.
Most researchers wishing to access or contribute to HPE journals will seek information from their websites. Our study therefore aims to explore the editorial policies and priorities of leading journals in HPE as declared on their websites. In doing so, we seek to highlight any potential opportunities for further growth of editorial policies in HPE journals at this exciting time for the discipline.
Methods
Journal selection
InCites Journal Citation Reports data base from Clarivate was systematically searched and independently reviewed by two researchers (ZA and MAR) in August 2021. This database was chosen as it provides data which are transparent, publisher-neutral, and widely accepted amongst the research community.
The database was searched using the criteria ‘Education, scientific disciplines’ as a filter. Following this, the inclusion criteria were journals which covered HPE, and which also had a 2020 Impact Factor above 1.0. This resulted in 14 HPE journals meeting our study inclusion criteria which were cross-checked amongst the research team.
Data extraction and analysis
The online websites for the 14 journals selected () were independently reviewed by two researchers (ZA and MAR) for their editorial aims, scope, intended readership, and priority topic areas. Two researchers (ZA and MAR) independently extracted relevant text from the websites and coded the data using thematic analysis.
Table 1. Summary of included journals.
Thematic analysis is the most commonly used approach to qualitative analysis in HPE (Ng et al. Citation2018). Braun and Clarke’s (Citation2006) pivotal work describes thematic analysis as a method to identify, analyse, and report themes within the data. We employed this method by first generating codes which represent certain concepts within the data and through an iterative approach, developed a richer understanding of the data set. We then explored the relationships between the concepts. Themes and codes generated from the data were discussed between the research team until a consensus on the findings was reached.
Results
As outlined in , the 14 journals included in this study were hosted across five different publishing companies, and 10 (71.4%) were linked to national or international societies in HPE. These journals were first published between 1926 and 2008, had impact factors between 1.355 and 6.893, and produced between 4 and 12 issues per year. Across the text extracted from the webpages of these 14 journals, a total of four themes were generated to describe their editorial aims and priorities: (1) methodological and theoretical rigor; (2) impact on practice; (3) global relevance; (4) advancing knowledge. provides illustrative paraphrased quotations for each of these four themes.
Table 2. Themes and illustrative, paraphrased quotations.
The theme of methodological and theoretical rigor reflected a consistent message from journals stating they would prioritise research with a clear theoretical basis and that is underpinned by a conceptual framework. Although journals seemed to welcome various types of methodologies, including quantitative and qualitative approaches, words such as ‘strong’, ‘sound’, and ‘rigorous’ were employed to describe editorial preferences. The theme of impact on practice, meanwhile, reflected a preference for research that would have a direct impact on clinical training and education. Some journals explicitly mentioned the need for ‘generalisability’, whilst others described that research must have ‘significance’, ‘relevance’, or ‘importance’ for educators. A number of journals explicitly stated who the research should be applicable to, listing groups or types of audiences (which were exclusively clinician groupings) to whom the research should be of interest to. Of note, the emphasis on impact was clearly on practitioners rather than policymakers.
The theme of global relevance was striking, in that the significant majority of journals portrayed themselves as being ‘international’ in some way. Journals described themselves as being platforms for international discourse and debate, as covering worldwide issues and perspectives, as reflecting the diversity of health and education worldwide, and as having international ‘scope’. One journal emphasised this through highlighting its distribution to readers in a high number of different countries. The final theme, of advancing knowledge, represented a clear desire for journals to advance the field of HPE by contributing novel and transformative findings. Descriptions of this advancement included the identification of ‘best practice’, solving current problems in the field, and promoting debate and dialogue. Whilst most journals sought to advance the HPE field in general, others had a specific focus on advancing knowledge within the realms of HPE scholarship and research, in particular.
Discussion
In keeping with widespread calls for HPE to develop into a more research-focussed discipline, this study found that the editorial policies of leading HPE journals prioritised high quality research methods and articles that advance knowledge in the field. Importantly, these policies also project an inclusive message that welcomes various different theoretical perspectives and contributors from across the world.
The primary focus of these journals is on creating impact at practitioner level, with comparatively less focus on impact at policy level. This is striking since many factors that determine HPE are influenced by policymakers and not individual practitioners. Notable examples of this include global systems for accreditation of medical schools (Pinsky Citation2020), structural mechanisms to align the social mission of HPE with healthcare services (WFME Citation1988; Burdick et al. Citation2011; Mullan Citation2017), and managing migration patterns and the impacts of ‘brain drain’ (Rizwan et al. Citation2018). Given that journal impact factor continues to be an important metric in academic promotion structures (Crites et al. Citation2014), the editorial priorities of these journals is of continued importance for the development of the HPE field.
Previous studies have similarly posited a potential need to shift focus in HPE research. A content analysis study of over 10,000 research articles in leading journals found that the literature focussed primarily on preparation for professional practice and individual learning. This study suggested that there had been little shift in the nature of medical education research over the previous decade, recommending a broader scope to include sociological, ecological, economical, and system perspectives (Rotgans Citation2012). That work, however, looked at HPE research articles, and not at editorial policies as our study has done. A bibliometric analysis recently found both an increase in use of knowledge synthesis within medical education and growing variability in methodologies utilised (Maggio et al. Citation2021). This echoes our study findings that HPE journals are seeking to include research from more diverse perspectives. Our study found evidence of HPE journal editorial policy encouraging articles which advance the field. This is in keeping with recent work on innovation article-types in HPE journals, although that work did conclude by recommending greater clarity from the journals on the requirements for this (Colbert-Getz et al. Citation2021). Finally, our study identified that HPE journals project themselves as inclusive and internationally based; however, there have been calls for greater diversity and global representation of journal editorial teams (Mazov and Gureev Citation2016; Yip and Rashid Citation2021).
Implications for practice
This study highlights how the editorial policies of HPE journals may be setting the agenda for the development of HPE as a scholarly discipline, particularly showing that focus to date has been more on individual practitioners than on educational policies. This provides an opportunity for editorial boards to consider further broadening their scope by encouraging the submission of work targeting policymakers, or by foregrounding this more clearly on their webpages. The rapidly changing landscape in HPE means that journals need to continually review and amend their editorial guidance. Our study suggests that increasing relevance to policymakers and promoting funding for HPE based further research are opportunities which are not widely covered at present.
Implications for research
Further research on differences between HPE journals and those in related fields such as general education and clinical healthcare would be instructive. Examining whether articles at the research-policy interface for HPE are also published outside of these general HPE journals in policy documents or journals in other fields would be important here. The ultimate impact of these both upon policies and the HPE community would of course be key. Further supportive work could focus on interviewing journal editorial teams to review their own priorities and rationale that they employ and the implications this has on the scope of the journal, as well as to seek the views of HPE societies that are associated with journals.
Strengths and limitations
Strengths of this study include the systematic identification of journals and extraction of text using two researchers who worked independently to extract and code the data. A broad sample of journals was included in the final search which covered varying disciplines within HPE, and a range of impact factors were included. The limitations of this study lie in its use of only websites corresponding to the journals being used as the primary source of data, which means there could potentially be further or different information published in printed journals. Additionally, the study was conducted at a single point in time and longitudinal analysis of changing priorities over time could have provided insight into the evolution of the editorial aims of HPE journals. The initial search criteria were based on journal impact factors from a single database which limits the sample, although does prioritise the journals that are likely to be considered most influential given the continued academic relevance of impact factors.
Conclusions
HPE journals with the highest impact factors have editorial policies that prioritise high quality research methods and impact on a broad audience of global practitioners. The comparatively reduced attention on policy impact identified in this study is worthy of further exploration, given that improving HPE globally relies on change at policy level as well as through individual practitioners.
Glossary
Impact factor: The impact factor of a journal reflects the frequency with which the journal's articles are cited in the scientific literature. It has gained acceptance in the academic community as a quantitative measure of journal quality.
Saha S, Saint S, Christakis DA. 2003. Impact factor: a valid measure of journal quality? Journal of the Medical Library Association. 91(1):42.
Disclosure statement
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Correction Statement
This article has been corrected with minor changes. These changes do not impact the academic content of the article.
Additional information
Notes on contributors
Zakia Arfeen
Zakia Arfeen, MBBS, DRCOG, MRCGP, SFHEA, is a Clinical Lecturer in Medical Education at UCL Medical School.
Tim Young
Tim Young, BSc, MBBS, PhD, FRCP, SFHEA, PGCert, MedEd, is an Associate Professor at Queen Square Institute of Neurology, UCL.
Mohammed Ahmed Rashid
Mohammed Ahmed Rashid, MBChB, MSc, MD, MRCGP, PFHEA, is a Professor of Medical Education and Vice Dean (International) at UCL Medical School.
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