Christmas message and update on EMJ.

Below is a short letter from Ellen sent out to the editors on the journal. It outlines where we came from, what we’ve done and where we are going. Although originally intended for the internal team I really felt this encapsulated how Ellen has led us to improve, develop and future proof the journal. With her permission I have reproduced it here.

Ellen Weber

From Ellen Weber. Editor in Chief. Emergency Medicine Journal

A holiday message from the Editor of the Emergency Medicine Journal

As 2017 closes, I wanted to take a moment to look back and reflect on what we have accomplished at EMJ and a bit about my vision and hopes for the coming years. We could not have gotten where we are without such a dedicated and talented editorial and publishing team, and the credit belongs to you.

There were two questions that I was asked when I started as editor of the EMJ. At my interview, I was asked: Who is the journal for – the author or the reader? At my first appearance at the CEM meeting, I was asked if the EMJ needed to be more selective.

These questions have helped to shape my vision of what I’ve hoped we can accomplish with the EMJ. First is to raise the quality of the articles we are publishing, and secondly to make the journal more relevant to readers. This continues to be my vision for the journal. To provide a high quality journal, that readers look forward to receiving, and which publishes research that has an impact on policy, practice and patient and physician well-being.

Here’s what we’ve accomplished so far:

Quality: We have set several editorial standards that have helped to improve the quality of the papers, while at the same time providing clearer guidance for authors so that their submissions are more likely to meet these quality standards.

All research papers must now be submitted with a research checklist. This helps to ensure that the papers contain all the necessary information on methods so we can evaluate them fully.

Statistical review: We have developed a cadre of statisticians who review almost all of the original articles before they are published. The statistical reviews have raised the quality of our papers immensely. It is extremely rare that a statistician does not find a major issue with the statistical analysis in the paper, despite prior content reviews.

Standards have been gradually implemented. We began with requiring that all clinical trials must be prospectively registered to be considered for publication, as recommended by the ICJME. We then added a requirement that uncontrolled before and after studies include an interrupted time series to account for secular trends. Authors are instructed to use confidence intervals instead of p values; sample size calculations must be included; surveys must have a clear response rate; chart reviews must report inter-rater reliability. We have essentially stopped publishing audits.

We are far more selective about what we publish; papers need to have generalizability, international relevance, clear implications for practice, an unbiased interpretation of the results, and an honest discussion of limitations. Our acceptance rate for original research articles is about 20%, which is typical of higher quality journals.

To educate the authors, we have published several editorials explaining our policies, and have included on our website a section that provides additional guidance on meeting our standards. The editor recorded 4 videos for the website to help authors understand what was needed in their articles and has spoken at a number of conferences to provide authors with guidance on how to write their manuscripts.

Our Impact Factor has improved, from 1.64 in 2013 1.861 in 2016 (2017 figures are not yet out).

Reader Interest and Relevance
While many of our readers are researchers as well, by far the majority are practicing physicians who may find it difficult to see how original research articles will affect their practice. We’ve addressed this in two ways: one, doing more to put the articles in context and explain the value to the reader and 2, providing other types of content that are educational and evidence-based.

Making research more accessible:

  • We have added a box at the beginning of each article that explains what is already known on the topic (i.e. where the paper sits in current literature) and then, how the findings of the study may affect practice or add to our knowledge.
  • Primary survey – The primary survey is not new, but is used to also provide background and context for the articles we are publishing in that issue.
  • Editor’s and Reader’s Choice – We developed these to highlight two articles per month. The Editor’s choice is free to access (as is any accompanying commentary) and the Reader’s choice is selected based on downloads from the website since it was published. Both are highlighted on the cover and their relevance explained in the Primary survey. Thank you Tomasso at BMJ for continuing to adjust our covers and TOC’s to perfection!
  • We have published articles that explain statistical concepts that appear in some of our research papers.
  • Article length: To the extent possible, we have attempted to keep all research articles to 3000 words or less through careful editorial suggestions, and have expanded the use of the “short report”. Shorter articles are preferred by busy readers.
  • Topic headings: We have recently created topic headings for groups of articles published in a single issue (e.g. Paeditrics, Geriatrics, Meeting Demand for Services) to help guide the reader to articles that may have special interest in.

Non-research articles that provide perspective, education, and insight. For example:

  • We launched the Top Ten, a brief review article that allows readers to quickly obtain new information, eg.. Top Ten Apps for the Clinician, Top Ten Ways to introduce In Situ Sim; Teaching Tips, etc.
  • The View from Here – This first person narrative allows readers to learn aboutunique experiences in practicing emergency medicine, or experiences that may change how they practice. Examples have included clinical experiences in limited resource countries, working with the elderly in the EDs, being a pioneer in the early days of emergency medicine.
  • Reviews: We continue to [publish both narrative and systematic reviews. However, we have begun a new type of review – Expert Practice Review. Experts are asked to address clinical questions that are relevant to the emergency physician or prehospital practitioner at the point of care. References are minimized to only those that have formed the experts’ opinion on those specific issues. The first of these is being published in February and a second is about to be accepted. Two others are currently in progress.
  • In Perspective – While some journals do a “journal review” where they cite a half dozen papers of interest from another journal, we feel that this is not very educational for our readers. For this reason, we’ve started the In Perspective series, where an expert in the field discusses the implications of recent research. Thus far we’ve run these on chest pain diagnosis, frequent use of emergency departments, the new ATLS guidelines, the association of costs of care and outcomes. These have gotten excellent coverage on social media.
  • Innovations in Emergency Medicine – These are short reports on new ways of delivering health care or adjunctive services. They have included a visual triage method for limited resource countries and a new legal service for victims of trauma. These innovations are often difficult to test formally, but generally have some metrics showing their success.
  • Image Challenge – Images in EM was converted to a quiz to provide interactive content and self-assessment. 

Social Media

Overall in the past year, our altmetrics scores appear to have improved from prior. This is difficult to evaluate as we don’t have a “journal” score, but on browsing our website, I see more high numbers than I have in the past.

  • “Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors” Altmetrics 125
  • Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence? Altmetric 131
  • Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial 14 2 (Picked up by 10 news outlets including Outside, Newsday, Medscape, Yahoo News)
  • Increased weekend mortality is not associated with adoption of seven day standards. Altmetric 245.
  • We have a monthly podcast of our primary survey..
  • We have 30 K Twitter followers.
  • A fantastic blog
  • We have an automated feed of articles when they are first released on line. 

We have clearly done a lot in terms of our quality, relevance and recognition. But we are not resting here. We have a great product. We need to ensure its sustainability and do more to let others know about what we have to offer! In the next years we will continue to work on improving our media presence, commissioning thought- provoking commentary, truly useful expert reviews. We will continue to work on shortening n turn-around times (Shout out to Princess and the EMJ team at BMJ!) and finding ways to attract high quality research papers.

Thank you all for your hard work to this point and I look forward to taking the next steps together with you.

All the best for 2018!

Ellen Weber

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