Winding up the series of workshops conducted at various medical universities in Saudi Arabia, Dr Trish Groves, Head of Research BMJ, Editor-in-Chief BMJ Open, editorial lead for BMJ Research to Publication eLearning Programme, said "there is a need for more studies on real life research questions that are highly relevant to the people of the Kingdom. These questions should be answered by studies such as randomized controlled trials of treatments and healthcare delivery, observational studies of prognosis and disease risk, and qualitative studies that could give insights into the needs and behavior of patients, doctors, and nurses." Asked about the preparedness of students to do and accomplish the goals of being successful heath researchers, she said she was "impressed by the commitment they and their medical schools are making to develop research skills. Not all countries do that." In an interview, she observed that much of the teaching in the BMJ workshops was aimed at building a high quality evidence base for medical care, public health, health policy, and clinical education: hence the lectures were focused on clinical and public health research. "I got the impression that there has been much investment in the Kingdom in the more scientific type of medical research (often called biomedical or translational research, mostly conducted in laboratories) with, perhaps, room to also develop more research that is directly relevant to healthcare, patients, and the population," Dr Groves noted. Excerpts from the interview follow: What was the outcome of the workshops you have conducted at various medical universities in Saudi Arabia? How do you gauge the participants' assimilation of the modules you have taught and presented to them? A: This was a great opportunity to meet hundreds of health researchers in the Kingdom, through conducting eight BMJ workshops and lectures in one week in Riyadh, Jeddah, and Dammam. The delegates were always engaged and keen, asking many excellent questions about planning, conducting, and publishing research. They were particularly interested in gaining insights into the policies and decisions at international medical journals. During and after the workshops, delegates tweeted and emailed much positive feedback. And, since coming back to the UK, I've received further invitations to come back and speak in the Kingdom in 2016. Have you identified limitations or handicap that these people in the medical field (doctors, researchers and students) have at present that they have to overcome in order for them to deliver the mission? What are they? What should they do to surmount those obstacles and develop and learn the skills expected of them to be able to write papers that can get published in top international journals? One way to compare the research outputs of different countries and regions is to look at what happens to publications, using so-called bibliometrics. The most commonly used measures are based on citation rate: this shows how many times a published article is referred to in another published article. This reflects the usefulness of an article to other academics and researchers around the world. Scholarly journals are also scored by the average citation rate for their articles, used to calculate a widely used metric called Impact Factor. Medical research from Saudi Arabia and the GCC currently has high rates of rejection from "high impact" international medical and science journals. For The BMJ, Nature and Science, rejection rates are almost 100%. In lower impact journals, the number of published manuscripts from the region is increasing, but citation rates are decreasing. This may reflect a requirement for almost everyone seeking promotion in medical fields to do some research. This is an incentive that can be effective, but it can also overemphasise quantity over quality of research. This is where BMJ's eLearning Programme Research to Publication can help. There is only so much that an author, professional medical writer, peer reviewer, or editor can do to improve a paper once the study has finished. It's far better to ensure that research questions are important, relevant, original, and well defined - and that these questions are answered using the best study methods. A study like that stands a great chance of publication in an influential and widely read journal. This is why BMJ is aiming to improve research at every step: through its conception, conduct, and publication. Are there any shortcuts to learn the skill and be adept in writing these papers? There is one shortcut: making sure that the research starts well. This means that every study should have a clear research question, a detailed plan or protocol, and a study design that is as scientifically and ethically strong as possible. Putting a lot of effort in at this stage will reap many benefits later, not least that the research resources and patients' time and goodwill is not wasted. Because study protocols are so important, BMJ Research to Publication has a whole module dedicated to developing and publishing high quality protocols. How important is this skill in the medical field? What benefits would it provide to the medical industry in Saudi Arabia and to the country's economy at large? The ability to conduct and publish high quality, relevant, research is vital to healthcare and the population. Studies conducted in Boston or Oxford may not always be relevant to patients or the healthcare system in Riyadh or Jeddah. Every country needs to have a relevant evidence base. This can be developed by taking the best locally conducted studies and synthesizing their results with the best research from elsewhere, using a technique called systematic review and meta-analysis. This is the strongest method for developing a truly relevant evidence base that can inform national and regional guidelines and policies to improve health. Indeed, Saudi Arabia would benefit greatly from also investing in training of systematic reviewers and information specialists who can help researchers to put their studies into the right context and help them make the most of their findings. Countries with high quality medical research are more likely to retain their highly skilled workforces in healthcare, reducing the "brain drain." They are also more likely to attract researchers and international collaborative research projects, and to provide a good home for pharmaceutical research. What are the chances for the medical professionals and students in the Kingdom to be accomplished authors in the field? Is language a barrier in becoming proficient in this endeavor? What is the best sure way to acquire the required skills, if there is any? Is there any step-by-step approach to be strictly followed? Although most medical research is published in English, language should not be a barrier for papers from Saudi Arabia. It is rare for a journal to reject a paper because the English isn't perfect and, anyway, this can be improved during the peer review and editing processes. It is also fine to work with professional medical writers and publication professionals, as long as their contribution is fully disclosed and acknowledged when papers are submitted to journals. There are strict and widely used rules on authorship for medical research, provided by the International Committee of Medical Journals. The key is that anyone listed as an author must have been a research in the study: it's not enough simply to have contributed to the writing. Each author also has to be willing to be accountable for the whole study: this means that the group of authors must work closely together at all stages, right from the stage of writing the study protocol. The most important point about writing up medical research is that the methods and results must be reported fully, even if the results are imperfect or disappointing. Studies that didn't go quite right, or didn't find the expected answer, are often important and well worth publishing. Who are the five lucky winners of the complimentary program you have initiated in partnership with the Saudi Digital Library? How assured are they that there research work would get publish in the international journals, much so in BMJ Open, after completing satisfactorily the one year "complimentary access through a ‘Research Capabilities Award'"? What's your simple advice to those who like to be competent in writing a medical research work/report and see the work publish in international journals? The winners were Dr. Mohamed Saeed Al-Shahrani - University of Dammam; Mohamed Bohlega - KSU – Student; Dr Marwan Abouammoh - KSU - Doctor/Physician: Academic Medicine: Assistant Professor; Paolo Colet - Shaqra Uni -Academic Researcher, Cynthia Mosher - Alfaisal Uni – Student. Congratulations to all. We hope that their complimentary access to the BMJ Research to Publication eLearning Programme rtop.bmj.com will help them to develop any research projects they may have, and help them to write successful papers. We will also be offering each winner half a day's advice on their manuscript, should they complete their research during 2016. All good journals, including BMJ Open, use independent peer review to guide decisions on which papers to publish: for this reason we will not be able to guarantee publication. To sum up, the best way to succeed in publishing medical research is to do a great study that will add usefully to knowledge and will help to improve clinical practice. — SG
