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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!


  1. Thank you Karin, for sharing these thoughts! I completely agree on the little to no actions taken by the medical profession on all open-issues. Being a medical student myself, I have stumbled across a set of different barriers while advocating for what is a no-brainer to us.

    I want to share a list of obstacles I identified to open them up for discussion:
    --> lack of knowledge: Rather caring about patients than publications, junior medical professionals are not aware of the problem of accessing knowledge (and data). The problem of paywalls can be solved by a VPN connection or the institution's computers. They are not aware of the annual fees their institutions pay for this commodity.
    --> limited influence on research and publishing decisions: When publishing your first papers, in form of case reports or audits, chances are high that you are co-author only and your more experienced supervisor is on there as well. He/she has a set of preferred journals, where he/she always publishes, knows the reviewers and thinks of his/her established readership. It will be really hard to advocate for a change to a different (open) journal.
    --> Data illiteracy: In Germany, the Dr. med. (MD title) has to be obtained by a small research thesis. Most often MD students find themselves as part of a well established lab in a large project where data has been collected for the last 5 years and still will be collected for the next 3 years. The working group uses SPSS and since the MD student needs to work only with a small part of the data for a small period of time, no one goes into depth explaining the different options for analyzing data (like “R” programming) or storage options. Even worse: If the student collects own data he or she will probably be asked to “leave the data with the lab” after departure, instead of making it available to the greater public.
    -->wrong incentives: As a junior doctor or medical student you will have to either wright a monography or publish your research to become a Currently you are required to publish a certain amount of papers in high Impact Factor, peer reviewed journals. So eventhough you are motivated to live up to open science principles, the incentive system almost makes it impossible to go the open way. This doesn’t only account for senior researchers, but also for medical students, who might not even search for a career in research.

    Altogether, I believe there is a great need to
    1. inform students about the advantages of Open Science
    2. teach the right skills (open statistical software like R, overview of CC licenses etc.)
    3. empower students and junior doctors to break with the norm or the opinion of their peers.

    All this has to be done through a positive approach. Only if we come up with ways that attract EVERY young doctor, not only those into open science already, we can make "open" the default option. I am confident that formats like “Statistical Analyses for dummies: How R made everything easier”, “How to make the most out of all this data” and “14 easy ways to get cited more often” could do a lot to strengthen the voice of junior in the Open debate!

    Peter Grabitz, 5th year medical student in Berlin

  2. Excellent Karin,

    Well said and to the point. If you ask me all "scientific " publication must be open access as the so called "peer review" system is to prevent new knowledge coming in.

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