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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Sunday, 13 March 2016

Open Access – where did all the doctors go?

The wide-open skies of America are a very happy place to which I have returned after an absence of nearly 8 months.  It’s amazing how quickly the reflex ‘hi there, how are you?’ rolls off the tongue and is greeted by an equally enthusiastic response (as opposed to British looks of confusion!).  It is pretty special to be back in the land of endless optimism, my home for nearly a year, and still feel like I belong!

A few of the OpenCon alumni at SPARC MORE
Endless optimism was certainly the vibe that was being channeled at the SPARC Meeting on Openness in Research and Education (MORE) in San Antonio, Texas, where it was my very great privilege to be speaking about developing an Open Access policy.  Standing in front of a group of field-leading librarians and policy makers as a doctor and L-plates-level scientist and telling them about your somewhat haphazard attempts to navigate the crazy world of policy development and research publishing was… well, oddly exciting.  Why? I found myself representing a voice that I didn’t even really realise was missing from the discussion.

MFA Likes Bicycles, Boston
Doctors. Where are the doctors? And I’m not talking about doctors who have joint clinical/research contracts, and I’m not talking about senior consultants or professors (amongst whom many amazing advocates of OA can be found).  I’m talking about baby doctors like me, for whom things like publishing a case report or an audit or maybe even a little clinical research project (probably in that order of likeliness) can not only provide important info to the medical community, but also add vital points to a job application, especially if you’re applying to a competitive specialty.  I was discussing this with the rather awesome Roshan Karn, a fellow junior doctor in Nepal, and we agreed these things were key stepping stones, and also provided a valuable opportunity towards more formal research.  Not only that, we SHOULD be writing these things up and sharing them with our community – if it's good or important, it should be shared, and surely it’s about a thousand times more efficient to try and develop/enhance a tried, tested and effective audit or Quality Improvement Project rather than starting from scratch. 
Spring came early this year to Yale-town!
 More than that, doctors and clinical practice are probably the most commonly cited case examples in favour of open access.  It’s a no brainer really – evidence-based medicine requires, well, evidence.  If we can’t read it (because it’s behind a pay wall), we can’t practice it.  And yet I’m not sure whether many junior doctors are aware of open access, let alone open data (which surely has its challenges where patient-based clinical data is concerned, but shouldn’t be dismissed as a whole on that basis).  We’re a bit different from researchers and scientists in that we don’t have specific funding – just our salaries – and therefore there is no mandate or direction when it comes to publishing open access.  Even if we are aware and want to publish open access, it’s not like we have any funding for any open access journals that charge an article processing charge (APC), aware as I am that some OA journals have a waiver or an alternative (much cheaper) system to APCs.  AND referencing my pre-conference article, we would still have to persuade our co-authoring consultants/attendings/registrars/
residents towards a journal or output format that is open.   

In short, junior doctors should be amongst the loudest voices in favour of open access, and yet we’re barely opening our mouths or being handed the microphone. 

Magic as ever, NYC
Now, I’m absolutely ready to be wrong about all of the above, and if you’re reading this as a junior doctor and thinking ‘hey, that’s totally not true’ then I would be positively delighted to hear from you!  Notes on a postcard J

There’s no value in complaining and not doing something about it, so I’m going to investigate… I’ll keep you posted.  Junior doctors should have a voice in this, even if we don’t have all the answers, and we should be aware of how to be more Open. 

Some fortunately-timed annual leave post-SPARC MORE means I've been lucky to have a whistle-stop return tour of the East Coast before hopping back across the pond - one week, four cities, four States, lovely friends, jet lag +++, epic skyping/whatsapp-ing = happy Karin! Open Access/Data/Education is about squeezing every last bit of juice out of the immense amount of information and knowledge out there  - I like to apply the same principle to every aspect of my life! Off I skip back to the hospital wards...
Old pals, new city!

Sunday, 6 March 2016

Open Access isn't easy - let's talk about that

A li'l bit of mountain magic from the last few weeks
Greetings, blog readers! Somehow nearly 3 months have passed and here we are – the flowers of spring have blossomed earlier than ever, the winter darkness is lifting and I’m now to be found as a junior doctor on an acute oncology ward. My absence from my blog has been for very happy reasons of work craziness and life loveliness, but finally I've found a spare hour for me, Spotify and a birds eye view of the snowy wilderness of Canada en route to San Antonio, Texas.

Chaps, it's SPARC MORE time!
(Read: YAY! Conference on Open Access – Meeting on Openness in Research and Education)

It feels like two seconds since OpenCon2015 in Brussels – as inspiring an event as one could ever hope to attend.  I was lucky enough to be invited to speak on a panel about the work Fulbright have been doing to develop an open access policy, and that’s what I’ll be chattering about in San Antonio, Texas this week.  More than that, I’m hoping to hear how we can keep moving forward with all the exciting open access/data/education developments that are happening all over the world. 

…Because Open Access – well – it’s bloody hard.  There, I’ve said it.  I am totally team open access.  When I need to know the latest evidence on a certain disease or treatment, I want to know without having to struggle past pay walls.  When I’m planning experiments in my research area of cancer biology, I need to know what’s been tried and tested, or how to implement a particular method, without selling half my grant funding for the privilege.  When I have something to publish, I want to know that people won’t experience barriers in accessing the information I’ve generated (bearing in mind that I am yet to be anything other than essentially government funded for all of my exploits). 

But as a junior doctor, I don’t have funding to pay open access fees, and I’m not sure my study budget would make much indent in Article Processing Fees (APCs) even if I could use them for that purpose.  Even now that I’m starting to be first author for a couple of papers, I still need the support of people far more senior than I who have their own careers to worry about, and therefore have their own ideas about where we should publish (although I will say people are broadly supportive when I raise the issue).  It’s really quite intimidating to raise your hand and tell a bunch of co-authoring Consultants that actually you’d rather this paper be published openly.  It’s also scary when you realise you might know the most about open access amongst your authoring team, and even then feel like you know very little.  Pre-prints, post-prints, embargo periods, green, gold, repositories, APCs, licenses, copyright…. Yikes!! I barely know enough about how to write and publish a paper, let alone all of that! 

We are working in an imperfect system of Impact Factors, Research Excellence Framework (REF) assessments, annual appraisals (in my case, both clinical and academic) and research output hierarchy.  We’re rightly asked to think outside the box and lead the change in publication culture by leaders in the open access field, but when you’re at the bottom of a very, very long ladder, it’s quite a daunting ask.  As a doctor, I find myself faffing around my need to competently do things as diverse as chest drains, talk to patients about terminal cancer diagnoses and manage patients who become acutely unwell, whilst simultaneously doing cancer research and being at the forefront of a new culture and direction for cancer research publishing.  Something amongst all of this has got to be easy, right?!

But as I’ve said before – just because something is hard doesn’t mean we should run away.  Open access is important in every field (science, humanities, the arts) and I’ve learned a great deal more about the nuances of this in helping US-UK Fulbright to develop their policy.  As a doctor, I see it in every patient for whom we care. The vast majority of what we do in hospitals is derived from some kind of research study – everything from the drugs we use to the types of beds we have, the dressings we use to the methods by which we do any procedure.  I look into the eyes of patients for whom we’ve reached the end of the line in terms of treatment for their cancer and wonder what therapy is being developed right now that might one day treat the same patient? Why should such knowledge be hidden behind a pay wall, or the data protected by copyright laws?


If that can’t drive me forward, then nothing can; but that doesn’t mean it’s easy.  This conference comes off the back of a rather intense few weeks at work – this junior doctor loves her job but working on an acute oncology ward of course comes as a package deal of giving something of yourself.  Perhaps that’s something that all things worth doing require?  

Check out the SPARC website and twitter (@karinpurshouse) to follow the latest news from the SPARC MORE conference.  Digestible potted highlights to follow!