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Original Article

Publication performance and research output of Neurology and Neurosurgery training institutes in India: A 5-year analysis Venkatesh S. Madhugiri Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

ABSTRACT Context: Scientific publications are a reflection of the quality of the clinical and academic work being carried out in an institute. Training in the process of research and scientific writing are important components of the residency curriculum. Aims: The publication performance and research output of institutes training residents in neurology and neurosurgery were  evaluated. Setting and Design: Internet‑based study. Methods: This study was based on the data available on the websites of the Medical Council of India and the National Board of Examinations. The PubMed search interface was used to determine the publication output of institutes over the past 5 years (2010–2014). Google Scholar was used to determine the citation performance of each paper. The publication parameters were normalized to the number of faculty members in each institute as listed on the institutional web page. The normalized publication performance for an institute was computed by comparing the figures for that institute with the national average. Results: Institutes could be ranked on several criteria. There was a high degree of clustering of output from the top 5% of the institutes. About 13% of the neurology intake and 30.9% of neurosurgery intake over the past 5 years has  been into the institutes that have not published a single paper during this period. Conclusions: This evaluation of the publication performance and research output of neurology and neurosurgery training institutes would serve as a baseline data for future evaluations and comparisons. The absence of any publication and research output from several training institutes is a matter of concern. Key words: Citation; clinical neurosciences; India; neurology; neurosurgery; publication performance; rankings; research output; residency programs

Introduction The training curricula for neurology and neurosurgery residents have been constantly evolving over the past several decades.[1,2] Residency training now involves the acquisition of core competence across several domains. These domains include clinical patient care, procedural Access this article online Website: www.neurologyindia.com DOI: 10.4103/0028-3886.158200 PMID: xxxxx

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skills development, theoretical knowledge, communication and teaching skills, teamwork and management skills, exposure to evidence‑informed medicine, training in research methodology, and scientific writing.[3] Since the quality of resident training directly affects the quality of clinical care and research, it becomes essential to monitor the skills acquired during the training period.[4‑6] The most important of these domains would obviously be clinical care, procedural skills, and theoretical knowledge of the subject. The success of a training institute in imparting these skills, however, is difficult to evaluate; the required information is often not easily available. One of these components, however, readily lends itself to quantitative evaluation and comparison. This is the exposure

Address for correspondence: Dr. Venkatesh S. Madhugiri, Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry ‑ 605 006, India. E‑mail: [email protected]

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Madhugiri: Indian clinical neuroscience training institutes

to research methodology and scientific writing, as measured by the publication and research output of a training institute. The number and quality of publications emanating from an institute can be construed to indicate (albeit indirectly) the quality of clinical work and research being undertaken in that institute. Thus, by extension, the degree of exposure of residents to these domains could be gauged. Publications and research output are factors that have consistently been used to rank institutes and training programs.[7,8] While the volume of clinical exposure in most training programs in India may be adequate, the adequacy of exposure to research and scientific writing is not known.[9,10] Although presentations at conferences also denote academic activity, the absence of a rigorous peer review and lack of a permanent record for peer usage make this activity inappropriate for evaluation and comparison. Indian medical colleges have been ranked by the print media as well by academic organizations.[11,12] However, till date, there has been no evaluation of institutes conducting residency programs in neurology and neurosurgery on the basis of their publication performance and research output. In this study, the research output and publication performance of institutes that train residents in neurology and neurosurgery in India were evaluated.

Methods The list of institutes recognized by the Medical Council of India (MCI) to conduct training programs in neurology (DM) and neurosurgery (MCh – 3 and 6 years programs) was obtained from the MCI website (http://www.mciindia. org/). However, similar information for the diplomate courses (DNB) was not readily available on the website of the National Board of Examinations (NBE, http://www. natboard.edu.in/). Therefore, the centers conducting DNB courses in neurology and neurosurgery were identified from the lists of seats offered in institutes as published in the admission prospectuses for super‑specialty DNB courses for the years 2013–2015. The lists of papers published by departments (neurology/neurosurgery) in the listed institutes were then identified as described subsequently. Step 1 The website of each institute was accessed to determine the exact listed departmental name – for instance in some institutes, neurology and neurosurgery were combined and listed as “Department of Clinical Neurosciences” or “Department of Neurological sciences.” Step 2 A PubMed search was built using the advanced search function to collate papers published by each institute. For all searches, 2 search

fields were employed. In SEARCHSET‑1, the first search string was the department/subject (neurology/neurosurgery) and this was searched as an “affiliation.” If a different nomenclature (besides neurology/neurosurgery) had been displayed on the website, this was used in addition to neurology/neurosurgery, in a separate search. In SEARCHSET‑2, neurology and neurosurgery were searched as Major Medical Subject Heading terms. In both search sets, the 2nd search string was always the name of the institute; this was also searched as an affiliation. Every effort was made to incorporate as many spelling and abbreviation variations as possible in this search term. For instance, if the word “Shri” appeared in the name of an institute, irrespective of the spelling listed on the website, separate searches were carried out using all possible spelling variations (such as Sri, Shri, Shree, Sree, etc.,). At some instances, as many as 7 separate searches were carried out for a single institute in each search set. For example, publications by the Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital were searched for using the entire name and various abbreviations thereof (such as PGIMER Dr. Ram Manohar Lohia hospital, PGIMER Dr RML Hospital, Dr. Ram Manohar Lohia hospital, RML Hospital, R M L Hospital, etc.,). The search limits were set to the past 5 years (2010–2014 inclusive). Step 3 For the next search, the institutional web site was accessed again to check if the names of the teaching faculty were listed. If faculty names were available, a PubMed search was performed using the name of each faculty member as an author.[13] The list of papers published by the faculty over the past 5 years were collated. Step 4 Lists of papers obtained by each of the several searches carried out were merged and duplicates eliminated. Separate databases were generated and maintained for each institute using EndNote® (vX7, Thomson Reuters). Each publication was categorized as a case report, original paper, and review article or as belonging to a miscellaneous category (response to comments, opinion piece, editorial, etc.). Case series describing  ≥4  cases were considered to be original articles. No distinction was made between basic laboratory research, clinical investigations or trials, translational research or case series – these were all categorized as original papers. The following calculations were then made: • The number of times each article had been cited in literature was determined by performing a search on Google Scholar (http://www.scholar.google.co.in/) • The ratio of the number of publications per year to the

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Madhugiri: Indian clinical neuroscience training institutes

faculty strength was calculated for each institute (total publications in 5 years/faculty strength) • In order to evaluate the productivity of each institute vis‑a‑vis the average performance across India, the publications per year statistic for each institute was compared with the national average. Thus, if Pi were to be the average publications per year for a particular institute i and P0 – the national average of Pi, the normalized publication performance (NPP) would be given by following formula that has been described previously- NPP =

Pi- P0 P0

[14]

• The quality of original work being published from the institutes was assessed as follows – institutes were first divided into quartiles based on the number of original papers published. All original papers published by institutes in the highest quartile were listed, and the citations received by these papers were determined. The institutes were then ranked on the basis of the number of citations received per paper. It was necessary to divide the institutes into quartiles based on the number of original papers published so as to select those institutes that had published a substantial amount of work over the past 5 years rather than an institute that had only published one paper that became highly cited. Thus, the quality as well as the quantity of published original work was assessed • The i10 index for each institute was calculated; this denotes the number of published papers (between 2010 and 2014) that have been cited at least 10 times since publication • The 10 year h‑index was  determined for each institute using Harzing’s software.[15] The h‑index is the number of publications (P) receiving at least P citations each from among papers published in the past 10 years (Np).

Results All results are current as of January 2015. A total of 223 neurology residency spots were available in 2014; these were distributed across 92 institutes. Of these, 173 (77.5%) were DM seats and 32.5% were DNB seats. 239 neurosurgery residency spots were available in 100 institutes as of 2014; 200 of these were MCh seats (83.7%) and the remainder, DNB seats. The distribution of these seats between the government and private sector is displayed in Table 1. Institutes running neurology residency programs A total of 1911 papers had been published by neurology teaching institutes in PubMed indexed journals during the 5‑year period 2010–2014 (both inclusive). The mean number 340

of publications/institute/year was 4.2 (±10.11); the median was 0.8 papers/institute/year. The average number of papers published by government institutes each year (8.16 ± 14.5) was significantly higher than the number published by private institutes (1.22 ± 1.66) (t = 2.97, P 

Publication performance and research output of Neurology and Neurosurgery training institutes in India: A 5-year analysis.

Scientific publications are a reflection of the quality of the clinical and academic work being carried out in an institute. Training in the process o...
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