Pediatrics in Review(PIR) is now in its 41st year. After last year’s publication of commentaries, blogs, and a supplement devoted to celebrating the past 40 years of the journal, what should PIR’s next step be?
Twenty years ago, the Accreditation Council for Graduate Medical Education described 6 core competencies in which practicing physicians should be skilled. One of those competencies is practice-based learning and improvement. At the end of PIR’s inaugural year, forward-thinking founding editor Dr Robert Haggerty, intent on improving the journal, reflected on readers’ remarks.1 Readers gave generally positive comments, and most readers appreciated the mix of review articles and abstracts of current studies. However, some just wanted new material, others solely the basics of standard general practice, and a few simply controversial topics. For all, writing quality was expected. This past summer, with practice-based learning and improvement in mind, the journal surveyed its readership. Forty years after that first year, generally the same reader comments appear.
Good things first. The survey response rate was significant. Readers ranked overall satisfaction with the journal as “excellent.” Content quality was “very high” and content relevance “high” to “very high.” Readers strongly valued authors’ expertise and felt that the journal served as a respected reference. The most-read journal features in order of frequency were review articles, In Brief, Index of Suspicion, Visual Diagnosis, and Teaching Slides.
Although many readers noted that they enjoyed the journal in its current form, some readers gave the following specific requests: shorter, clinically relevant, and practical review articles geared toward the primary care setting; an associated column in each review listing practical points; more articles that concisely discuss recent AAP Policy Guidelines; more up-to-date articles on controversial topics and headline pediatric issues; and more in-depth reviews on mental health issues (especially anxiety and depression), adolescent medicine, musculoskeletal injuries, and child abuse.
These reader responses raise 4 underlying questions that warrant the journal’s attention. First, with the development of pediatric hospital medicine, the role of the general pediatrician is dramatically changing. Children with more acutely complex and severe illnesses are being treated in emergency departments and in hospitals by pediatric emergency physicians and pediatric hospitalists, whereas children with preventive care needs, or with developmental, behavioral, and mental health concerns, or with stable yet chronic complex problems are being treated in the outpatient setting. Does PIR publish articles for all pediatricians who practice in emergency department, hospital, and/or clinic settings, or does it focus more on topics appropriate for the general pediatrician practicing outpatient medicine? At our annual editorial board meeting this past October, our members, half of whom are general pediatricians, resoundingly responded that the journal should continue to cover both inpatient and outpatient general pediatrics. Second, mental health is a significantly growing concern in pediatrics, and there are not enough mental health experts available to handle the depression, anxiety, and suicide rates that now plague our children and adolescents. Should PIR publish more mental health articles to help general pediatricians treat patients with these health issues in their practice? Third, as more infants and children with complex, sometimes technology-dependent, chronic care needs survive and are discharged to outpatient care, should PIR establish a chronic care feature? Fourth, while medical information is increasing and changing at a logarithmic rate, how should the journal keep pace with providing this information in a readily accessible, highly readable, and qualitative way?
Most readers (including residents, young pediatricians, mid-career pediatricians, and senior pediatricians) prefer the printed version of the journal for several reasons, including portability, ease of reading, ease of highlighting and excerpting (“tear outs”), ease of referencing, and overall aesthetic. Yet, a sizable number of readers prefer the online version of the journal due to ease of accessibility. Some of these readers suggest that the journal provide more video and interactive content. In today’s pervasive push for online publishing, how should PIR balance online versus printed content?
The PIR editorial board consists of young pediatricians, mid-career pediatricians, and senior pediatricians, some in general pediatrics and some in subspecialties in either academic medicine or general practice, who actively advise how best to improve the journal. All editorial board members follow Dr Haggerty’s philosophy of “Not all of every issue will appeal to our readers but I hope that all will find the majority of material in each issue useful.” Answers to the questions mentioned in this commentary will come as the journal steps into the next 40 years. Reader input will help keep the journal on course.
1. Haggerty RJ. Editorial: one year’s experience. Pediatrics. 1980;1:299