An Issue of a Journal is More Than the Sum of Its Parts

Kanter, Steven L. MD

doi: 10.1097/ACM.0b013e3181b34599
From the Editor

Do you like the “feel” of a new issue of a journal? Do you look forward to opening the latest one as soon as it arrives, to see what is “hot off the press”? Does it feel good to be the first one to fold back the cover—bending it carefully and precisely—to crease it in just the right place? And are you willing to admit, if I promise to keep it confidential, that you even like the smell of the fresh, never-before-read pages?

Well, smell and feel as much as you can now—pull issues of your favorite journals close to your whiffer and inhale deeply—because, for some of them, new issues may not be around much longer. At least, not in their current form. (Please note that Academic Medicine does not plan to stop producing a print version of the journal. However, given current trends in scholarly publishing, I think it is important to begin to consider the consequences of doing so.)

More and more journals are moving to article-by-article publishing on the Web, and the idea of an issue (and certainly the pleasing stimulation of the tactile and olfactive senses by a bound, paper-based issue) is quickly becoming a thing of the past. All of which has left me wondering about the value of an issue–and in particular, about what we might be losing as paper-based issues give way to the alluring ease of posting individual articles to a Web site.

So, what is an issue of a journal? I know what it used to be. It used to be a printed and bound collection of articles and related material, including news items, book reviews, commentary, art, and advertisements. You still see these around today, but generally the only persons holding them are quite “long in the tooth”! There was a time when you would see each resident or medical student with a copy of the latest issue of one of the prominent clinical journals sticking out of his or her pocket. In fact, white coats were made with carefully measured oversized pockets to hold such things. And even if the residents or students really didn’t read the issue, they knew that it looked good to have it in their pockets, especially on rounds or when visiting the department chair. It made them look eager and curious to know the very latest ways to take good care of patients.

But today, residents, medical students, and even faculty carry silicon-based, hand-held devices that not only fit in smaller pockets but that can access almost any article in any journal. So, as we move to a world without paper-based journals, what is an issue? And more importantly, are there aspects of an issue that we should strive to preserve?

At its best, an issue can be much more than the sum of its parts. An issue can be an integrated collection of articles and related material that has the potential to bring coherence to a set of ideas, beyond what any one article in the collection could do alone. A well-crafted issue can stimulate thinking in new and creative ways, lead to a cross-pollination of ideas that traverse traditional disciplinary boundaries, catalyze dialogue on important controversies of the day, and even galvanize community action around critical matters.

Editorial teams (editors-in-chief, associate editors, managing editors, staff editors, editorial board members, and others) work toward these goals by grouping articles in meaningful ways, developing calls for papers on important themes, developing special features that blend thinking in different fields, and soliciting commentaries on key topics. Commentaries that present cogent analyses of articles appearing in the same issue can enhance that issue’s content by providing a broader perspective for understanding fundamental topics and by linking together the ideas in different articles into an integrated construct.

Also, there is one important feature of an issue that must not be overlooked—the “surprise me” factor. What is the “surprise me” factor? Over the years, I have heard people talk about this factor in different ways, but basically it means, “When I open a new issue of a journal, show me something interesting that I did not know, and that can accelerate my thinking in new directions.” It is the article or commentary or letter to the editor that evokes in a reader the reaction of gleeful surprise: “Wow! Isn’t that interesting? I am so glad I saw that.” Or even, “Every time I open the pages of that journal, I see something new and intriguing.” The “surprise me” factor can refresh and revitalize thinking, but must be implemented by an experienced and knowledgeable editorial team who knows its audience well.

There are a few other concerns related to the issue of a journal that have become such an ingrained part of our culture that we might not ordinarily think about them. For example, current versioning and indexing practices are based on traditional notions of an issue. Article-by-article publishing demands reconsideration of these practices along with the development of new citation structures and standards (e.g., the issue number is a part of most citation standards). Even something like the page number cannot be taken for granted. It, too, is a part of almost every formal citation method, and new approaches to marking the order of pages are being discussed. Of course, the absence of regular publication dates will necessitate new workflow routines1 for those who produce journals. Although such changes may be cast as a matter of logistics, they must, nonetheless, be handled in effective ways.

And what about Academic Medicine? Our editorial board continues to discuss advances and trends in scholarly publishing, including article-by-article publication, and I will report the results of those discussions in future editorials or on Editor’s Notepad (

As more and more journals embrace article-by-article publishing, it is my hope that they also find innovative ways to preserve the fundamental ideals that add quality and value to the traditional journal issue: bringing coherence to a set of ideas, stimulating the imaginations of readers, catalyzing dialogue and galvanizing action within a community, and offering a few surprises here and there.

Steven L. Kanter, MD

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1 The National Federation of Advanced Information Services. Best Practices for Publishing Journal Articles. Available at: ( Accessed May 25, 2009.
© 2009 Association of American Medical Colleges