Innovations in education and clinical practice.

In this issue of the Journal, we announce our plans to introduce a new section entitled “Innovations in Education and Clinical Practice” (see “Information for Authors” at the back of this issue). This section is intended to promote publication of articles that describe innovative approaches which might influence education and patient care, but have less rigorous evaluations of data or outcome measures than those required for the “Original Articles” or “Brief Reports” sections. We hope that this new section will capture the interest of our clinician-educator readers and inform them about the creative ways in which their colleagues are dealing with educational and clinical issues. We also hope that it will allow a diverse group of authors to contribute to the Journal and promote the career advancement of clinician-educators by facilitating publication of their scholarly work. For clinician-educators whose scholarly interest relates to medical education, we offer the “Innovations in Education” component of the new section. In September 1997, the Journal published an editorial, “Our Continuing Interest in Manuscripts About Education,” with the goal of increasing the quality and quantity of articles related to medical education.1 Guidelines were provided to help authors improve the caliber of submissions and convey important and useful information to readers. This appeal, however, did not result in a significant increase in the publication of education-oriented material. In fact, education-related manuscripts constituted 6% of the original articles published in 1998 compared with a mean of 16% over the previous 5 years, and the total number of articles related to education (including brief reports, reviews, perspectives, and editorials) was down compared with the previous 2 years (1999 Annual Report to the Editorial Board). It became apparent that placing the entire onus of expanding the educational content of the Journal on the authors was not a successful strategy. In light of this, this new section has been developed as a middle ground. We are committed to sharing with prospective authors the responsibility to ensure that the content of the Journal will more accurately reflect the priorities of the Society of General Internal Medicine (SGIM) and the skills and interests of its membership. Topic areas envisioned for this component of the new section include, but are not limited to: ♦ curricula addressing previously unmet needs, ♦ innovative educational methods, ♦ teaching evidence-based and cost-effective medicine, ♦ teaching in the presence of the patient, ♦ precepting in a busy office practice setting, ♦ teaching population and community-based approaches to primary care, ♦ patient education, and ♦ continuing medical education. For clinician-educators whose focus is on clinical practice, we offer the “Innovations in Clinical Practice” component of the new section. In April 1996, the Journal published an editorial announcing a new section, “From Research to Practice,” the purpose of which was to encourage thoughtful pieces on the application of research findings or epidemiologic concepts to daily clinical practice.2 However, only 12 articles were published in this section from May 1996 through September 1999. “From Research to Practice” will be subsumed in the new section, which invites submissions on a broad array of applications and developments in clinical practice. Topic areas envisioned for this component of the new section include, but are not limited to: ♦ application of research findings in practice, ♦ improving the doctor-patient relationship, ♦ improving the quality or cost-effectiveness of care, ♦ advances in patient education, ♦ facilitating behavior change, ♦ practicing evidence-based medicine, and ♦ improving practice operations. Often, clinician-educators find it difficult to publish their work in peer-reviewed medical journals because it does not meet the demands for rigorous study designs, research methods, and evaluations, and for statistically significant results. A lack of funding may be responsible for many of the limitations commonly observed in studies of educational interventions. External grant support for research in medical education is limited.3 Thus, many projects have to be funded directly or indirectly by the investigators' institution, or by the investigators themselves. The lack of financial support impacts all aspects of a study or curricular project, from intervention and evaluation design to data collection and analysis. Closely related to the lack of funding is the way most clinician-educators must spend their time; the vast majority is spent caring for patients and teaching.4 Therefore, it seems unrealistic to expect their scholarly contributions to possess the same degree of scientific rigor and thoroughness as those of investigators with funded protected time. These expectations probably impede the dissemination of information about creative new developments in medical education and clinical practice. Some readers may be concerned about publication of articles that have small numbers or unrepresentative samples of subjects, that employ nonrigorous evaluation designs which cannot control for potential confounding factors, that focus on subjective more than objective outcomes, and that fail to demonstrate durable changes in knowledge, attitudes, skills, or performance. These are well-founded concerns about deficiencies that may threaten the validity of many studies. Nevertheless, we feel that such shortcomings should not necessarily preclude the publication of interesting new approaches to educational or clinical practice if there is an important story to be told. These limitations can be noted and discussed in a well-written paper. Such papers may offer valuable, innovative, and practical perspectives on what can be accomplished in educational or clinical practice. Although evaluation criteria will be different for this section than for other sections of the Journal and may result in publication of manuscripts that might have been rejected in the past, accepted manuscripts will still adhere to scholarly standards. Manuscripts will be chosen on the basis of a variety of criteria, such as their contribution to the existing literature (which should be documented), innovativeness, perceived relevance and usefulness to our readers, written and conceptual clarity, the methodologic and conceptual soundness of the intervention or evaluation, and quality of the discussion (strengths, limitations, and implications). The Journal will try to provide reviews and editorial comments that help authors prepare articles for publication. Finally, we would like to thank the numerous SGIM members and Journal readers who offered suggestions for this new section. We hope that “Innovations in Education and Clinical Practice” will be a welcome addition for our clinician-educator readers and provide an opportunity for publication for clinician-educator faculty.