Publications in Academic Medical Centers: Technology-Facilitated Culture Clash

Berner, Eta S. EdD

Academic Medicine:
doi: 10.1097/ACM.0000000000000216

Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others’ words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.

The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed.

Author Information

Dr. Berner is professor, Department of Health Services Administration, School of Health Professions, and professor, Department of Medical Education, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Berner, 1705 University Blvd. #590J, Birmingham, AL 35294-1212; telephone: (205) 975-8219; fax: (205) 975-6608; e-mail:

Article Outline

In the mid-1980s I started using a word processor to compose my research publications. I remember a colleague warning me that people might think I was the department secretary if they saw me typing, because at the time faculty wrote their papers by hand and secretaries did the typing. Today, I would be seen as either inefficient, old-fashioned, or just an incompetent typist if I gave all my typing to the secretary. Whether the personal computer is responsible for a more egalitarian academic culture is debatable, but other academic values, culture, and traditions may need to change as a result of the use of technology. Unfortunately, we have begun to deploy the technology without changing our culture, resulting in clashes of values. In this essay I discuss three of these areas and describe how the traditional academic culture is now facing challenges.

Back to Top | Article Outline

Technology and Academic Culture

Technology and education

In traditional face-to-face classroom teaching, lecturers long ago gave up the chalkboard and slides for the PowerPoint presentation, which is also a staple of presentations at professional meetings. And because such lectures filled with bullet points can be overwhelming or boring, and because research demon strates advantages to including visuals in presentations,1 who amongst us has not spiced up our presentations with a cartoon, photo, or other apt image, easily found on and incorporated from the Web? That we may be violating copyright does not even occur to many of us.

Traditionally, lectures often synthesize the ideas of others with minimal attribution. In our spoken lectures, and even on our slides, we often include abbreviated, rather than full, citations and may not clearly indicate which of our words are direct quotes from other sources. It may not even occur to many faculty, who would never fail to fully attribute another person’s work in their publications, that such use of images and ideas is inappropriate in their teaching, perhaps because publications are widely disseminated and permanently available and lectures are not. This view may be a carryover from the days of unrecorded spoken words and regularly erased blackboards.

PowerPoint slides are clearly more easily disseminated than old-fashioned photographic slides, and today many instructors provide them for their students. By giving students our slides (with the cartoons, photos, etc.) we ourselves not only disseminate these slides and images but also allow the control of dissemination to be out of our hands. The issue is even more serious with online classes and the new massive open online courses.2 As asynchronous distance learning programs increase, we will see even broader and more permanent archiving of the instructors’ words and slides online. Not only are audio and video lectures recorded and posted on the Web, but often transcripts of the lectures as well. In a sense, what in the past was a one-time presentation has now become a published speech with accompanying visuals. And with that change, publishers are increasingly sensitive to the violations of copyright or absent attributions that are now both more common and more visible. In fact, academic institutions have been sued for violation of copyright as a result of instructors who used copyrighted materials in their online courses.3 Interestingly, news of these actions usually appears outside the realm of peer-reviewed literature and thus may not routinely be read by many faculty. The important message is that, in this age where our academic products are potentially public and permanently accessible, our traditional approaches to preparing, disseminating, and archiving our lectures need rethinking.

Back to Top | Article Outline
Technology and presentations at professional meetings

Professional scientific conferences are a mainstay of the academic medical culture. Graduate students and junior faculty are strongly encouraged by their mentors to present their research at conferences for many reasons. The conferences uphold one of the strongest values in academic research—that of investigators sharing their results with fellow scientists and getting feedback so that they can eventually publish a peer-reviewed paper on their work. Presenting at conferences has other benefits, especially for junior faculty. It is an opportunity to meet the leaders in the field, network with others with similar research interests, and, as a practical matter, it can justify being reimbursed by the institution when travel budgets are limited. In addition, the large annual meetings are often the focus of professional associations’ activities and are a significant source of their income.

As important as conference presentations are, it is the peer-reviewed publication that is seen as the gold standard for promotion and tenure in medical schools. Despite the fact that many conferences require abstracts that are lengthy, structured, and peer-reviewed, neither these abstracts, nor the presentations themselves, are considered as important as publications. In part, this may be for the same reasons that lectures have not been considered publications—conference presentations were neither broadly, nor permanently, available.

Technology has challenged the assumptions about the significance of conference presentations. Increasingly, professional organizations are archiving conference presentations (slides and sometimes audio, video, and/or transcripts, and even the original abstract submissions) on the Internet, making them available to a broad audience. In part, this is a reflection of the same academic culture that values transparency and sharing that brings people to confer ences in the first place. In addition, to avoid publication bias, it is often recom mended that authors of systematic reviews include conference presentations in their analyses, because many of these presentations may not get published in any other form and because they are now available for review.4

Yet, despite the fact that conference presentations are now widely accessible and at least somewhat permanent, the status of peer-reviewed publications as the sine qua non for academic promotion and tenure has not changed. Making presentations at meetings and then reworking them into publications remains the norm in academic culture.

In addition to the value of sharing one’s discoveries, the avoidance of plagiarism and duplicate publications is another value strongly upheld in academic institutions; this is another area where new technologies are being applied. Organizations concerned with research integrity have advocated the use of plagiarism detection software to more effectively find evidence of plagiarism or duplicate publication, and publishers have begun using such software.5 In fact, many faculty use plagiarism detection software in their own classes.

Although academic medical faculty abhor plagiarizing other people’s work, they may not consider the reuse of their own material to be a problem. For example, many researchers in large studies use a standard methods section for all publications related to that study. This practice ensures clarity and consistency when discussing different aspects of the results. In addition, the introductions to various publications on the same or related studies are likely to include similar citations, if not actual repetition of text. Abstracts (and presentations and posters) from professional conferences that are archived on the conference Web sites often include study results. And all of this material is now easily discovered by the plagiarism detection software that the peer-reviewed journals are beginning to use routinely. Use of this software would not be a major problem if the journal editors and the academic researchers shared the same values, which they do about plagiarizing others’ work; that is, if both groups agreed that conference presentations should not count as prior publication and that reusing parts of one’s own work is acceptable.

Unfortunately, it is not clear that they do share those values. At the same time that academic professional organizations are making scientific presentations broadly accessible, academic publishers may consider such wide dissemination prior publication. The guidelines for Academic Medicine, for instance, do not count short abstracts of up to 300 words as prior publication,6 but presumably the longer abstracts required for some conferences would be prior publication. The Lancet has published its intent to use plagiarism detection software to weed out “text recycling,” which is sometimes called self-plagiarism.7 The Committee on Publication Ethics (COPE), to which most major medical scientific journal editors look for advice, has recently asked for a discussion of text recycling, and will likely issue some guidance for editors. The online discussion that followed the draft guidelines highlights some of the conflicting views on this topic.8 Currently, journal editors make the decision what to do if they find such text recycling. These decisions could range from a discussion with the authors, through rewriting parts of the paper, to rejecting the paper altogether.

As an example of how these values collide, a colleague of mine, after making a panel presentation at an academic conference, submitted a manuscript based on the same research to a major medical journal. The professional association had archived the original panel proposal on its Web site. The journal’s publisher accepted the manuscript, but asked my colleague to rewrite those parts that overlapped with the panel proposal. According to the COPE guidelines, the publisher could have rejected the manuscript outright if the overlap had been significant.8

The ethical issues surrounding text recycling are not new, but technological advances make text recycling easier to detect and the practice of open dissemination via the Web potentially make it more prevalent. The problem is that academic professional associations and publishers have adopted technologies (Web publishing and plagiarism detection software) because they are easy to use, but the faculty culture and practices have not changed from the time when the spoken word was rarely archived, publications appeared only in print, and text recycling was difficult to detect.

Several factors may contribute to the lack of culture change around these issues. One factor is the scarce discussion of these issues in the peer-reviewed literature. Another is that, because faculty hold such strong feelings about plagiarism, to be accused of “self-plagiarism” may carry an aura of shame that inhibits open discussion.

The issue is not whether text recycling should be avoided at all costs or seen as sometimes appropriate and valuable; the issue is that (1) academic researchers and journal editors may hold different opinions, (2) faculty may not see the conflict or consider the consequences, and (3) without dialogue about the issues, change is unlikely to occur.

Back to Top | Article Outline
Technology and research publications

Another area exists where new technology plus cultural lag add up to difficulties. The National Institutes of Health (NIH) require researchers who receive support from the NIH or NIH-funded academic centers to deposit their publications in the public access repository at PubMed Central.9 Other federal funding agencies are likely to make public access a requirement as well.10 Most academic principal investigators funded by NIH know about this policy, and many journals, when notified by the authors of their NIH support, assist them by taking care of the processing and depositing of the article at PubMed Central. Some researchers, however, either don’t know about the policy or fail to take the necessary steps. Some researchers simply fail to properly cite their support. Sometimes, the corresponding author is unaware that a coauthor has received NIH funding and thus fails to notify the journal. Other authors routinely cite support from NIH-funded center grants, sometimes even on research that has not had center support, not knowing that such a citation invokes the public access rule.

The National Center for Biotechnology Information, the home of PubMed, has developed electronic tools to assist researchers in managing their bibliographies.11,12 These new tools can also help NIH-funded centers “claim” publications associated with support they’ve provided, whether or not the publications explicitly cite that support, something they certainly want to do to demonstrate productivity in their annual progress reports. The tools also make it easier for the NIH to monitor adherence to public access requirements. Both of these activities were quite difficult before the availability of these new technologies.

However, situations in which NIH-funded centers claim research that has not been made publicly accessible will very likely lead to charges of noncompliance. As of July 1, 2013, this, in turn, will lead to the NIH delaying payment for noncompeting continuation grants.13 Although remedies are available, they are cumbersome and challenging, especially when the authors who need to correct the problem are not at the institution or do not see the urgency. This situation is another example of a culture or strategy that was not very problematic in a nonelectronic age, but that has not quite caught up to the reality of the impact of the technology.

Back to Top | Article Outline

Implications for Academia

Academic culture needs revisiting

Several themes run across these examples. The first theme is that a culture that was reasonable in a nonelectronic academic world may need revisiting. There are several common issues or practices that may need to be reexamined. One involves use of copyrighted materials for teaching. Although fair-use copyright rules14 may protect the lecturer who downloads a copyrighted cartoon for her in-class presentation, it may no longer be fair use if that lecture is disseminated broadly on the Web. A second issue concerns the high value placed on peer-reviewed journal articles as evidence of academic productivity. When published journal articles are not the only form of broadly disseminated, peer-reviewed scientific products, and scientific conference presentations and abstracts are included in published systematic reviews, we may need to rethink the relative weighting of the evidence for scholarly productivity.

Back to Top | Article Outline
Ethically borderline academic practices

A second theme is that we academics have accepted some practices that may be ethically borderline, in part because the low probability of negative consequences made them seem not very serious. In the past, incomplete attributions in spoken presentations, use of copyrighted visuals, or overly aggressive citations of grant support were unlikely to be challenged. The current wide availability of these materials in electronic form coupled with other technologies that can search and find them has not only heightened the probability that there will be consequences but should also make us more conscious of the ethical issues and lead to a reexamination of some of these practices.

Back to Top | Article Outline
Culture clashes among academic stakeholders

The final theme is that clashes of cultures can occur among academic stakeholders, all of whom are operating with high ethical and scientific values, but where the values are conflicting. Neither researchers nor the journals in which they publish condone plagiarism or duplicate publication. Professional societies and researchers value sharing scientific results quickly. Medical faculty and publishers hold peer-reviewed publications in the highest regard. But the values of academics and publishers may conflict if publishers consider Web-based conference abstracts, posters, and proceedings as prior publications or, when submitted to the journal, as text recycling. They will also conflict if standard method sections and introductions across multiple articles from a large study are disallowed. These conflicts may always have existed, because the journal publication guidelines are not new, but available technologies are bringing them to the fore.

Back to Top | Article Outline

Concluding Reflections

We academics can change if we must, but the issue is broader than simply adapting to new norms. With effort we can rework introductions and method sections to vary across articles. We can forego conference presentations entirely and focus only on publications. And we can refuse to allow any of our presentations to be archived on the Web. But these actions also have consequences, especially for graduate students and junior faculty who need the visibility that conference attendance provides, for professional societies whose conferences are a major part of their mission, and for science, which progresses best with the free exchange of information.

Many of these issues have no clear answers, but with the continued advancement of technology the challenges to our existing academic culture are likely to increase. Maybe, over time, just as we’ve stopped dictating to secretaries, our academic culture and values will evolve to fit a technology-driven, not paper-based, world. Getting to that point will require significant changes to our current academic way of life.

Acknowledgments: The author thanks her colleagues Lee Vucovich, MLS, Justin Starren, MD, PhD, L. Russell Waitman, PhD, and Meg Bruck, MSHI, whose exchange of ideas on these issues helped shape this manuscript.

Back to Top | Article Outline


1. Berk RA. Research on PowerPoint: From basic features to multimedia. Int J Technol Teach Learn. 2011;7:24–35
2. . Major players in the MOOC universe. Chron High Educ. April 29, 2013 Accessed January 4, 2014
3. Howard J. Long-awaited ruling in copyright case mostly favors Georgia State U. Chron High Educ. May 13, 2012 Accessed January 4, 2014
4. Higgins JPT, Green S Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. London, UK Cochrane Collaboration Updated March 2011. Accessed January 4, 2014
5. Office of Research Integrity. . ORI Newsletter.;20(3) Published June 2012. Accessed January 4, 2014
6. Academic Medicine. . Editorial policy, publication ethics, and complete instructions for authors. Revised March 2013. Accessed January 4, 2014
7. Kleinert S. Checking for plagiarism, duplicate publication, and text recycling. Lancet. 2011;377:281–282
8. Committee on Publication Ethics. . Text recycling guidelines. 2013 Accessed January 4, 2014
9. U.S. Department of Health and Human Services. . National Institutes of Health Public Access. Updated 2013. Accessed January 4, 2014
10. National Science Foundation. . National Science Foundation collaborates with federal partners to plan for comprehensive public access to research results. Published February 22, 2013. Accessed January 4, 2014
11. Lindsey WT, Olin BR. PubMed searches: Overview and strategies for clinicians. Nutr Clin Pract. 2013;28:165–176
12. U.S. National Library of Medicine. . My NCBI—new features for my bibliography for eRA Commons users. Published July 12, 2012. Accessed January 4, 2014
13. National Institutes of Health. . Changes to public access policy compliance efforts apply to all awards with anticipated start dates on or after July 1, 2013. Published February 14, 2013.–042.html. Accessed January 4, 2014
14. U.S. Copyright Office. . Fair use. Copyright. Reviewed June, 2012. Accessed January 4, 2014
© 2014 by the Association of American Medical Colleges