Doctor Sadiq Naveed. I'm associate professor of psychiatry at University of Connecticut, Connecticut. I'm a lead psychiatrist in the for child and adolescent inpatient units at Hartford Hospital Institute of Living. I'm also chair of Apna Medit Research Committee and also chair of Apna Young Physicians Committee. Today, we are here to talk about a really important topic, how to improve the quality of research publications, and journals in Pakistan, and I'm honor to introduce our guest speaker today and panelist today. Our guest speaker is Doctor Farooq Azim Rathore. Doctor Farooq is a consultant, associate professor in rehabilitation medicine at Armed Force Institute of Rehab Rehab Rehabilitation Medicine Rawalpindi. He describes himself as a teacher, a researcher, and mentor. He is passionate about teaching skills and has conducted more than 00 workshops on medical writing, scientific misconduct, research ethics, presentation skills, faster city management and stroke rehabilitation in five countries of the world. His areas of research are spinal cord injuries, stroke rehabilitation, amputee management, disaster, rehabilitation, medical education and bioethics. Uh welcome Doctor Rator. I will also like to introduce our panelist as we are getting this chance. Doctor Professor Asad Aslid Khan. He has been recognized with Sitara Imtiaz by government of Pakistan. He is serving as director general administrator for Punjab Human Organ Transplant Authority. He is professor Emirates Emirates professor. He's also serves as COVID coordinator for Punjab. He's also a member of WHO monitoring team for vision twenty twenty. So I would like to hand over my two Doctor but before we go there I will also like to introduce and recognize Doctor Shahid Rafiq who has been an integral part of leadership of merit committee. Thank you Doctor Shahid Rafiq for being here. Mike is yours, Doctor Torban, you are ready. Thank you, Dr. Naveez for the introduction and thank you Apna for the opportunity.

Just let me screen, share my screen. Okay, so, can my participants please confirm that they can hear my voice and see my screen, the first slide, how to improve the quality of research, publication, journalism in Pakistan, a simple yes in the chat box would be sufficient. Yes, someone answered in. Okay. Okay, yes. Okay, that, okay, I will start off. So, before I formally start, a little bit of a disclaimer and couple of acknowledgements. First of all, this presentation which is on a very important topic is primarily based on my own personal experience and interaction. My journey of research and writing like many others in Pakistan or developing countries started off without any formal institutional support. So, I started off I published my first article as a thirty resident back in year 2017. That was more than 15 years back. Over the years had a chance to collaborate with many people all around the world and so far I have multiple publication with multiple authors all around the globe including Northern America, Europe, Australia, Japan, China and obviously Pakistan, India, Bangladesh and other developing countries as well. So I have a little bit of idea how this research culture works in the developing world particularly in a Pakistan. What are the challenges being faced once you are a young resident or a undergraduate student? And what challenges would you face once you start publishing national and International Biomedical Journals as a young and then maybe as a mid carrier faculty. And one important thing that I would like to ah disclose that you know this is going to be sort of a bilingual presentation. So primarily my mode of presentation is going to be English but you know ah secondly I would like to acknowledge my colleagues ah in Pakistan Association of Medical Editor Dapami. So we have a very active WhatsApp broke ah couple of days back I sent them an online questionnaire. I am really grateful that within ah twenty4 hour I received 30 responses.

And most of the responses were from senior hierarchy and leadership. They were editors, sub editors, associate editors and editorial board members. And I have incorporated their wonderful insights into this presentation as well. So before we start of we need to understand the past few ah past, present and the future prospective in medical research and writing and general publication. So I would like to take you back in history. When Pakistan came into being in 1947, around 77 years back, there were only two medical colleges. King Edward in Lahore and Dao Medical College in Karachi. With an approximate enrollment of 500 medical students, that was all. We did not have even a single medical journal being published from Pakistan and we did not have even a single over own indigenous residency program in Pakistan at that time. When we came into being. Alhamdu over the last 78 years. As of twenty twenty-two, we have 184 medical and dental colleges registered with Pakistan Medical Commission all around Pakistan. There are 99 medical journals, biomedical journals which are listed in Park Medinat, the largest local medical database of Pakistan and there are more than three hundred and 6 000 registered doctor and dentist with Pakistan Medical Council. So, I would say this is an achievement and specially I would like to say today because we are living in a time where everyone talks of disappear. When everyone talks you know I would still like to say you know we started our journey from nothing. There are always light at the end of the tunnel and the glass is always half full. It all depends perspective and what you can contribute to the system and to the country. So be positive and look forward. In addition to that we have lot of medical students studying in these 184 medical colleges. These thousands of students are curious, they are eager to learn and they are tech savvy. Which is a very important sort of skill that can be helpful in writing and publishing in national and international biomedical journals.

In addition to that we have thousands of resident and road in different programs all around the country. These residents are enthusiastic. And not all but most of them are really hard working. yes, many of them they want to excel in their professional lives. And this collaboration can actually lead to great results both for the individuals, institutions and ultimately for the country. I told you we didn't even have a single residency program when Pakistan came into being. As of today, there are 78 accredited programs of fellowship with the College of Physicians Surgeon Pakistan and around 22 membership program. Around hundred programs in the country at present only by CTSP. I am not counting the MD and the MS program run by different organization and institution and universities all around Pakistan. If we talk of the publication trends in Pakistan, again this was a very important article that was published back in year 2013 around nine years back. So, Vikima Singh, he and his colleagues, they conducted a pretty simple search. So, what they did was they went online on PubMed or the Medline and Scoopers which is a very large database. And they try to extract that what are we are the article that are published or authored by primarily by medical students. Ah not going to go in detail but this is one of the most inspiring graph that I always try to show to my student, to my young faculty member. In year 2013, in that global survey, you can see he mentions USA, United Kingdom and Canada. He also mentions Iran. Out of the 220 countries in the world at that time, he actually mentions medical students from Pakistan who had a lot of contribution as medical researchers in the international biomedical literature. and rest of all the world has been categorised as the category other. So, I tell you there is still hope. The glass is half full and there is always light at the end of the tunnel. Most of these medical students of two thousand thirteen are now either young faculty member or young consultants or about to finish their training.

So, they are going to join the school and actually improve the future for this country. Another, you know, historical perspective. So, Schemego in two thousand twelve, they ran forecasting excise. So, they do this exercise every four to five years and they forecast that what would be the output, what would be the regional output in term of research and what would be the output of countries in term of research and writing and output stuff like that. So, back in 2thousand twelve, they predicted that Pakistan which is located in the Asiatic region is going to have the second largest jump in the world apart from Malaysia. And Pakistan is hopefully going to ah ah go up sixteen ranks from 4-three to 27 in the world in the number of research article being produced. This is not specific to biomedical research but general research culture of Pakistan. And this actually happened. So this was a very big news that broke in 2018 and was ah mentioned by nature that Egypt and Pakistan in year 2013 had the highest rise in research output. It was something great. It we celebrated this thing. And you know other possible indicator that we can see in the country in the last 20 years are. Now there are many annual research days, seminar and conferences specifically geared toward undergraduate medical student and resident. Who can first present their research and then publish it in local and National Biomedical Journals. There has been an increase in the number of offices of research integrity or what we call RX and research departments in many medical universities and medical colleges and medical institutes all around Pakistan. And now we have students and residents specifically who have better skills, a better understanding, and a better passion for research and writing even more than their teachers and supervisors. And as faculty members, as teacher, we have to acknowledge this.

We have to support this attitude and we have to sort of like guide these youngsters who have enthusiasm time and a will to work. And this collaboration is going to produce good results. And because of all these things now there is a strong evidence which has been published in multiple articles that there is an increasing trend of conducting and publishing research both at the undergraduate, post graduate and faculty level. And that's why research is the new buzzword in Pakistan. You mention the word research and whether the other person is a student, a resident, or a faculty. They sort of get excited. And you know they start saying article I am going to be a published author and who so ever sort of like manages to publish X number of article. He or she is a class apart. This what usually happens at least in Pakistan. But I would like you to please zoom out and take a pause here. All that glitters is not gold. All that is published and being reported should be scrutinized. And we need to ask question. So probably the first question that we need to ask is. So why do physician, resident, and student publish so much? Why there has been a massive increase in the number of publication? What is the quality of these publication what is actually written in this publication? Are these publication ethically correct? Are they being retracted? Or are there any issues? And we are going to answer these questions. So students usually they want to publish because they want to improve their portfolios to increase their chances of residency and matches abroad. And that's fine. That's a very genuine sort of like thing to do. The residents they have to do certain number of publication as a part of mandatory requirement of their training programs. Ah sometime for CPSP and sometime for medical universities. MD and MS programs. And obviously faculty member usually write because they have to attain a certain number of publication in order to fulfill the requirement for the next academic promotion.

So these are the mostly reason for which people write articles. So ah those of you who have been attending my workshop both online and offline I would request they should not comment on this but from my other colleagues and other attendees can you please interpret this particular picture for me in the context of presentation that I am giving. What do you think this picture portrays? What is your interpretation of this picture? You can write it down in the chat box. I'll give you a minute and then we'll move on. So what is your interpretation of this picture? rat race and nothing of quality as such. The rat race, okay? Even if you win, you still are at perfect, fantastic. Authorship race, competition. Good excellent, anything else? Any other interpretation? You guys are pretty close. Different strategies to start a race. Pakistan politics focus but we are not politics today. So, we'll refrain from that. Rat race. Okay, so thank you very much. Yes, I totally agree. So, this is basically a rat race and this is my interpretation and please remember, in life you have all the right to agree or disagree with the person or the presenter. So, my interpretation is this is a rat race and these are the important sort of like participants. This is these are the faculty and consultants and you know, these are the resident account resident and you can actually identify these residents from the Smith on their faces and these are the student and as you can see, these students are much bigger in size. They have more energies and they are actually going to crush you if you don't have the required amount of knowledge and skills that you can transfer them as a part of your teaching program. And yes, this is a rat race to publish more and more. And unfortunately, this is my interpretation. These are our regulatory authorities. I will not name them, you all know them very well. So, these are the authority that are going to sort of like publish guidelines, not not guidelines.

They are sort of going to publish different letters. So, this is the new criteria for promotion. Okay, that's fine. But have you actually seen the culture in Pakistan. Do you have seen the support system of research in Pakistan? Do you see how we work in this over constraint system? Do you know the challenges that we face on a daily basis? What is the support that you are offering? Their least concern. They are going to issue regulations, do this and do that without realizing that you know in order to achieve a goal, you have to equip the people. And unfortunately a result of this, rat race, people are involved in publishing more and more without giving any attention to the quality. And as one of my colleagues just mentioned, the trouble with this rat races is that even if you win, you are still a rat with a large number of article which do not make any impact on the national or international scene. So, please go back and look around or even look at your own publication in the last 10 years. If in the last 10 years, you have published 50 articles, 50 manuscript. And you have not even gathered let's say 100 or 200 citations. I am really sorry your articles or manuscripts are not make it any difference in patient's life. They are just run of the male article which are being published for the sake of publication. But they are not making any impact on the biomedical scene. So I ask this question to my ah panel of experts of Pakistan Association of Medical Editors. And ah my question was in your opinion or experience has the quality of medical research and writing improve in the last two decades. And as you can see three quarter of them actually said yes ah the quality has actually ah improved ah but when I ask the question do you have any concerns about the quality of medical research in publication ah ah from research being published in Pakistan as you can see majority of them had concerns and I also share these concern and I am going to sort of like ah ah narrate them for you.

So the challenge is the first challenge that we face is actually ah little expertise and minimal funding to conduct medical research. You need to understand if you want to publish good quality research that is going to a certain amount of training, a certain amount of dedicated time and obviously funding. You cannot have good quality, randomized control trial and good quality interventional studies if you do not invest in your researchers, in your clinicians, and in people who are involved in research. And this is a major issue being faced by researchers and clinicians in Pakistan. Then you know ah being in Pakistan and working in this healthcare system where at least in public sector hospital sometime even consultants have to see more than 100 patients in a single day. They actually at eight in the morning and they stop at four in the evening. And then they have to start with their own private practice at the in their own time. So how they are going to conduct and publish high quality research. So there is a shortage of time. There is no protected research time even for the residents who are enrolled in the CPSP and other MD programs. And there is no protected time for the research for the clinicians who have to wear multiple hats. Right? And there is unfortunately a lack of institutional support. Just because out of 184 medical colleges, 10 or 20% medical colleges are offering support does not mean that other medical colleges are at par. So, medical colleges, many medical colleges do not have well equipped libraries. They do not give access to literature searching. They do not give access to detection software. They do not have appropriate bio statistician available on board and unfortunately still the demand from their faculty and resident and students publish more and more so that our institution can grow. I am sorry it won't happen like that. and in one of the columns that she wrote in ah Dawn. Ah this is a general comment on research not specific to medical research but at least it is very much applicable in medical research as well and she says apart from the course work the Pakistani institution offer no help to enhance students understanding of research and dissertation writing.

So and this is very very true. That we simply perform two or three exercises, workshops and that's it. Doctor Hushik says that research programs at most public department in Pakistan highly dubious and purely a mockery officer. And unfortunately in the last ten, 15 years, we have seen many cases of fabrication and polygonism and many high ranking official even the rank of a rector were caught doing plagiism and other things. And the research that they published was labelled as dubious and of high low quality. Unfortunately, nothing happened. And doctor Fatima Jawad, editor in chief of JPM is ah once ventured that original biomedical research meets the international standards is scars in Pakistan. So these are the challenges that we face. And Anju Maltaf actually gave a very damning statement and very direct he is one of the former provost of Habib University Karachi. And he said the quality of research in Pakistan were always poor and continues to be so. Can you cite any ideas emerging from Pakistani institutions that had global or even regional impact or recognition. So this could be one of the litmus test for the research that you perform. If your research makes a difference in patients and people's life. If it makes a difference healthcare policy, if it is being quoted and cited repeatedly, this means this is a high quality research and the time you spend in writing that research paper in national orientational biomedical literature was worth it. It will be cited and it's going to be sort of ah a tool for changing lives. But if it's not like that, you need to reconsider your strategy. So these are the concern about the quality of research in general of Pakistan based on my own personal experience and my colleagues experience.

The first is unfortunately low quality single centre observational study. Pick up any biomedical general of Pakistan. Index for non index. Most of the article that are published are of low quality. I'll tell you what I'll do I mean by low quality. And they are single centre observational studies. So this is the hierarchy of evidence based medicine pyramid. And you know as both escalation, as physician and healthcare and as author and students, we need to aspire to write and read the highest form of evidence which is matter analysis and systematic reviews. But if you go and analyse the article being published in Pakistani biomedical journal, most of them are either non randomized controlled trial or simple cohort studies. Which means their quality is not as high as a randomized control trial or an international trial. Second concern is that of lack of originality. One what we call a run of mill article or me too articles. So, article institution from ten parts of the country. I'll give you one example. So, couple of years back, I wanted to do some research on epidemiology of stroke. And I was amazed to find that there are more than 30 articles on epidemiology of stroke and most of those article are single central study having around 100 to 2 hundred ah sample size and they are published from multiple areas of Pakistan. We don't even have a single large scale epidemiological data about stroke, neurological disabilities and other issues. Small articles which do not make any impact because they are very regional and they do not give you the bigger picture. And then unfortunately ah we have to ah admit this bitter reality. Most of the research is being done for the sake of promotion only. At least for the faculty. And let's be honest. It is ah documented in literature as well. So, a survey was conducted in Karachi ah three medical colleges. And I would say their faculty was very honest and upfront. 71% of the respondent admitted that they were not really interested in doing research.

And they were only doing it for getting promotion. So if you make a culture where you are supposed and forced to do research somehow. Where ah the ant justifies the mean. You simply bring in some article by any mean. And you know neither your senior professor, head of department, your head or your committee they are concerned article how this article was created published and what was the process will it make an impact so then you only get articles by any means possible and that's why people do research and peer review process for most of the medical journals is not up to the mark so on the part of author you know authors are crying you know like our article take eight to 12 months for the peer review 8 to 12 months, you have to wait for 1 year and you have to ah request and send emails to to the editor editor and the editorial office again and again. And not in every case but I have faced this dilemma myself. In many cases the editors even do not bother to respond. And you are flabbergasted. You are frustrated that what should I do? Unfortunately and once you receive the peer ah review report unfortunately not in all but in many cases the peer review report is very poor quality. And we know in some cases how the peer review is performed in Pakistan. And many developing countries. So because you know the head of department of professors he or she is the man in that subject. So he would get like 20 articles in one month for peer review. Obviously he or she cannot do that. He is very busy. And he is going to send those article or share those article with union faculty member or residents. So you can please do the peer review for me. So how would you expect a resident to perform a good peer review if he or she has not been formally trained and the result is a very poor quality peer review report which we often gets very late to the author. And then on a personal note, I think the major issue with Pakistani journals and Pakistani research and research and developing countries are the ethical concerns.

The ethical issues. It doesn't matter how good you are in such methodology and by statistics. If you are a manipulator, if you do not follow the principles of ethics, it does not matter at all how good you are. And the major concerns are number one course of authorship. So, supervisors, head of departments, routinely they force, they blackmail and they ask their juniors, their faculty member, their youngster, their residents, you write articles for me. You put ah ah my name as first author and every article that you will submit. And the other person cannot say no. Because they are dependent and they are in a hierarchical structure. Unfortunately it happens very commonly. If you want to close your eyes, that's fine. I know many personal examples. I know many institutional examples. Mutual support authorship, again very common. And people don't even think it's wrong. We are helping each other. Ah this is not ah let you know by ethics. So I am not going to go in detail. But let me tell you very clearly. As per all international guidelines, mutual support authorship and coercive authorship are categorized as unethical authorship. And if you are caught doing that, your article will be retracted and you can face consequences. Duplicate publication, again. common still in Pakistan. Ah in the last three years I have myself, me and my team. We have picked up three duplicate publication. And one of ah at least one of them was already accepted for publication. But grateful to the editor that we highlighted it to the editor. And she withdrew the publication. So again very common. Ah people write one article for one general that gets published. The simply like make small changes and send the same article to another non index journal. And it is happening unfortunately. Ghost writing, gift lots of shape, you know, you give authorship to your seniors, to your consultants and your HODs and stuff like that.

Ghostwriting I'm going to discuss in detail a little bit, fabrication, falsification, juta, data, data not being collected and data being manipulated and unfortunately it has risen to this level that people and some people involved in this business they don't feel any shame in that. They don't they know you know like ah the law, there is no law for that and our regulatory authorities mostly are sleeping and they are no least bothered. So this is actually a service being offered from Pakistan on medical assignment writing. The person has given their ah email ah their email. They have given their WhatsApp number, they have given their mobile number. You can contact them and get the service. I am not saying you should do that. It's totally unethical. And they are offering article writing and thesis writing service in cardiology of endogeniatic hematology. Look at this list. This is unethical. But if you need an article, you will get an article. Very unfortunate and people are doing that So this is also a major issue we are which are we are facing. Again, look at this doctor Adrish. He is very confident and one of the team member very proudly mentioned in this website that I have written 41 thesis. Obviously for others, fake thesis. Again, this is unethical and it's a major concern. And this is something beyond this what I'm so on Twitter. This gentleman who is a a journalist in the news. He shared this. So people are actually advertising these kind of services in openly in newspaper. And they have no issue in sharing their mobile numbers. You know HEC recognize journals category may research paper publish ah and in which it means HEC higher education commission of Pakistan has certain categories. Ah X ah X, Y, W, X, and Y, high categories. So if you want to get an article published in these categories, please contact us. We'll take money from you and somehow we are going to manage an article publication for you in this journal. Total unethical.

And this is on Facebook. Add name in a paper. Approved by HEC, CPS PMDC, PMDC, AJK, ABC, DFG. And unfortunately, HEC, CPSP, PMC and PMDC are least concerned that what people are doing and the quality of work they are producing just because they sent a regulatory letter couple of years back. So, this is something that we all need to stop and ponder. And this was something that came up couple of months back ah again very ah just curious and a very ah it's a mega journal. It publishes thousands of articles. So they recently launched this curious wall of shame. Why I am a particularly ah focusing on this. Unfortunately again at one end in 2013 our medical students they made a name from themselves by publishing good articles. And in two thousand twenty-two, many Pakistani ah institutions and researcher were named as one of the people who were involved in unethical behaviour. And look at this person in the last. Rahil Barkat Saab. Rahil Barkat has 15 art retracted. I am pretty sure many of us have not even published 15 articles and this gentleman has fifteen articles retracted from curious because of data theft, fraudulent IRB approval and he charged co-author for authorship despite few or no contribution. So, this is what is happening and this is part of our research culture, very unfortunately. And one of the main reason is we do not have formal research ethic training in Pakistan. The education and training in biotic human research ethic are generally lacking. Not universally taught at a separate subject either to undergraduates, post graduates and even to faculty member. Only few medical colleges and institution are teaching research, ethics, as a separate sub subject. And please remember, clinical ethics that we face in our clinical ah practice is a bit different from human research ethics. These are two different things. You need to differentiate. And I'll give you quick ah a quick example of CPSP. So CPSP to It seems like we're having some internet issues internet might have frozen.

I know he has logged in from another system. So we'll just wait for a minute. And so far, we have been, through an interesting presentation and very powerful, I also want to encourage everyone to if they have any questions, post them to a session. Um, taking just advantage. Can you guys hear me? Yes, I think Congress speaker is having problem. Okay. So, while we are waiting for Dr. Raj. Oh, sorry, sorry, sorry. My net got disconnected. I am going to go on my backup device. Just give me a minute. Just give me a minute. Sure, sure. And just, you know, while, Dr. Rator is trying to reconnect. Doctor Asad Aslam Khan cannot join us because of some clinical responsibility. So, I requested Doctor Murad Musa Khan to join us. He's a professor at Department of Psychiatry Khan. Um Doctor Khan has served as president of International Association of Suicide Prevention in the past. He has published numerous articles and has been recognized in Pakistan and nationally for his work in in on the topic of suicide. So, thank you Doctor Murad Musa Khan for being with us today. I really appreciate that. Thank you for inviting me, Dr. Naveed. Glad to be here. Thank you. Dr. Attor, are you ready to I'm back? Just give me a second. I'm back, just give me a second. So please ask questions in QA, section, and we'll be happy to talk about them. Thank you. Apologies and yeah. Oops. This is not the one. And Professor time is right now at twelve thirty-four So, you know. Oh, yeah. I'll just take 10 hours more. Just keep it a sec. Yeah. So apologies for this. Yeah. So again can you please just give me a second. Yeah. So again, can you please confirm if you can see my presentation and yeah. Please say yes if you can see the presentation. Okay. Yes, we can. Okay, yes. So, coming to the last part, how to improve the quality of research, publication, generals in Pakistan. So, first of all, we isn't any any echo here or? Okay. Okay, thank you. So, first of all, we need to understand the ecosystem of research publication in in Pakistan or anywhere.

So, I feel there are six important stakeholders in this process. The authors, general editors, ear reviewers, the readers, the general health information consumers and the regulatory authorities. And once we talk of how to improve the system, we need to understand a chain is only as strong as its weakest link. Each of these very very important but if you again ask me probably the most important missing link is trading in research ethics. This should be the most important thing on which we need to focus as individuals. As teacher, supervisor, institutes and regularly authorities. So these are some of the suggestions for improvement based on my own personal experience and on my suggestion that I received from Pame. Number one, there should be mandatory research, ethics training at all levels. We should start it at undergraduate medical student and medical training levels for all healthcare professionals. And then it should continue to the post graduate education level and refresher courses must be held both for faculty member and supervisors. And this training ideally should be sponsored and sort of like ah held by the institution. But you know in 21st century every person is also ah responsible for their own self learning and improvement. And I am going to share certain resources as well. Number two, we have to strengthen the research governance system in Pakistan. There is lot of published evidence that says that most of the institution review board and ethic review committee of Pakistan are unfortunately what we call a rubber committee. Most of the ah IRB and ERC only have physician ah involvement. They do not involve the nurses and non paramedic and non-medical staff including healthcare healthcare consumer and patients. So we need to strengthen our IRPs and ERCs and sort of make them function in an appropriate manner. We need to have better training and support for authors.

And this could be in form of courses and on the part of institution, access to literature. We need to understand that access to literature is very very important. But sometime very very costly. You have to have solution for everyone. And this is going to improve not only the research culture. It is also going to improve the quality of clinical care in Pakistan. Because it's going to be based on the principle of evidence based medicine. Then you have to incentive lies authorship. I am not saying you start giving out money for that. Incentive could be in many forms but unfortunately apart from the faculty promotion there are no other incentive for which a person should spend their own energies, time, finances, resources in order to publish high quality research. So again depending on the institution there must be some form of incentive for those who involved in high quality medical research and writing. Then a major issue that is being faced by Pakistani author is ah and specially author who are at the undergraduate medical student level or resident is article processing charges. And I am not only talking of international journals which are somewhere between 500 to two thousand ah ah dollars and many of them will only give you a waiver of 50percent. And for a person in Pakistan even ah like arranging five hundred US dollar for a article is going to be a major major challenge. I am talking about Pakistani journals. Now many Pakistan good Pakistani generals are also charting somewhere between 20 to 40, 000 for publication. And you know it sometime become challenging for young resident and students. So we have to support these resident and students in form of some grant or some kind of scholarships. Then the editorial process and appointment system has to be improved. Ah again in some cases at least which I know personally ah specially when ah new medical institution or a new medical college or a new medical university establishes a new medical journal. So you know the senior most or the professor or all the professor of all the department head of departments and the principal they automatically become patron in chief, editor in chief, associate editor and stuff like that.

So they sort of like hold all important position but do not contribute. This process should be based on face selection. On some kind of criteria. We should focus on people who have the required skills whether they are youngsters or whether they are juniors. And once a editorial team is ah established must be provided appropriate technical administrative and financial support. Running a journal is not an easy job. It cost a lot of money. You have to provide them financial support, administrative support and appropriate technical support. Then you have to sort of provide incentive and compensation. It is important. This is how the world works. So you are asking someone to sort of like do an extra job of running a whole ah journal but you are not providing any incentives at all. So would the person sort of leave the clinical practice and other thing and focus on the journal. You have to incentivize it and compensate them. Then the editor is also responsible. They have to ensure a robust and fair peer peer review process system. If some peer reviewers are repeatedly laid despite reminders. So despite the fact that they are very senior and expert in their field. You might want to look for other alternatives. Please do not waste the author's time for months on and months on. Then of articles. So recently we had a kind of discussion with ah couple of my colleagues who are senior editors. So, some of the randomized control trial that were being published in a particular category were of low quality. So, again, you know, I am so grateful to my senior colleagues that they admitted that there was a like oversight on their part but we need to have a more robust editorial selection process. Then, you know, editors must ensure that the author adhere to reporting guidelines and this is sort of a global of ah trend that is coming up that there are certain guidelines and you can go online on equator network more than 528 reporting guidelines are available and any kind of article that you want to write the reporting guideline is available here most of the International Biomedical Journals now that demand that you have to download that guideline and you have to check all the tick boxes and then you have to submit that so probably Pakistani editors can do at ah do this as well and it will improve the quality of research publication in Pakistan the institution, organization, regulatory borderies must clearly define the role of clinician, accommodation and clinical researcher.

Confused you know am I ah part of faculty? I am a part of the hospital. Should I do learning or teaching or research? We are not clear. It should be clarified. Then ah please promote quality and not quantity just because someone has published 100 article does not mean anything. If he or she does not have any impact. So instead of like number of article go for the impact factor of general. Go for the number citation that the person has gathered over the last one decade and go for the all metrics as well, Right? Alternative matrix. And then you have to support your ah faculty member by research grants and publication fees. Again the article processing charges. And for authors and my ah colleagues who are listening to this webinar. Please write and promote systematic reviews. For many of us unfortunately we will never get the kind of support that we are will be able to conduct a large undermise control trial all round Pakistan with ten thousand enrollments. I am sorry it will not be possible for many of us. But still we can write a high quality systematic review which would be actually even better than randomise control trial. So please clear in how to write a systematic review and start publishing. It's going to give you a lot of dividends, citations and prestige as well.

And last but not the least is my personal opinion. To everyone who is involved in this process. Please do not launch new journals. Improve the existing one. Ah almost most of the journals that are being ah establish in the last couple of years are affiliated with a particular medical universities and the only aim is to allow the faculty member to publish their low quality research in order to fulfill the criteria and then climb the next step of academic promotion. That does not contribute to the overall research culture of Pakistan. So, just give an example. In the last 15 years, the only medical university that has consistently produced the largest and the best number of medical articles in Pakistan is Afghan University. That is a university that has the resources to establish a medical journal. They haven't done that. They invest in their people. They invest in their researchers. They invest in their faculty and they help them produce and ah ah ah publish high quality articles in high quality journals. So you might be want to do that as well. There are many resources for training and peer review ah I am going to give you the copy of presentation. So will not go in detail. Just want to tell you that the world has moved on and opened up everyone. So please be proactive and start exploring these online resources so that you can also learn the art of peer review. Web of science, voter clover, ACS Institute, this is one of the best the researcher academy and all of these courses are free of course. They would not cost you even a single rupee. So, will enter a science master peer review by PRF. So, there are so many resources available in order to help you become a better author and a peer reviewer. So, the take home I'll start with sort of a request and what I feel should be the role of Apna considering that the amount of expertise you guys have, the amount of enthusiasm that you bring to the table. So, you must support the research ecosystem of Pakistan.

I know many of you are already doing that but I would sort of like put forward some more suggestions. Number one, please increase the number of research, seminar, webinars, and courses specifically geared toward research writing and bioatics training in Pakistan. And we know that everything can be done online. There's no need of like and many of you do come. So, please do contribute in this thing. Number two is formal mentorship. And this mentorship should not only be limited or restricted to undergraduate medical student. Many of us were not formally trained in research writing when we were students. So, honestly, even as a faculty member, many of us are not very confident in research and writing. We also need mentorship. So, please offer a formal mentorship for all caters. May it be head of department or may be a first year medical student and you know like because you people work in a system, you have resources, you have vegan, probably you can help your country in a much better way. Ah we also need technical and academic support obviously including language support. Ah poor English language is one of the top ten reason for which articles are rejected from international biomedical literature. For authors based in developing countries like Pakistan. Our first language is not English. Many of our young colleagues they write excellent they conduct excellent kind of research. But unfortunately they cannot publish because they cannot like write it in appropriate English language. Many members of Apna have these kind of skills. Please help us out. And then ah depending on your skills you might want to help us in research methodology. Doing some research and active in the US and bio statistics. And please ah do ah some kind of collaborative research because you guys have the expertise, time, resources. People back home have a huge load of patient. So we can give you and provide you access to the patient that honestly you might never seen your life in USA, in UK or like other countries.

But we still have diseases, those disease pattern and those issue that still need an answer. So, please do some kind of collaborative research. And last but not the least, please do sponsor some training courses. Maybe APCs and some of the good quality research courses and they cost some money. So, instead of like, you know, I am not saying you dish out money, don't give that. Maybe you give out some ah ah you can ah talk of the logistics but you need to sponsor training courses for young enthusiastic students. and faculty members. And for everyone else you know it ah learning is your own responsibility. And you have to take your responsibility instead of blaming others or being jealous. Seeing somebody somebody else's success as your failure is a cancerous way to live. So stop like blaming others. Resources available and please remember we rise by lifting others. Whatever we possess become of double value when we have the opportunity of sharing with others. If you shares one piece of knowledge with someone else, it's going to come back to you in some form 1 day. That's a promise. And for the senior hierarchy, faculty members, the illiterate of the twenty-1st century will not be those who cannot read and write. But those who cannot learn, unlearn and relearn. Medical science is improving, changing, ah transforming on a yearly or a daily basis. What we were taught 20 years back sometime does not even two in 21st century. We have to unlearn and then relearn. I know it's a very difficult process for people like me and you but we have to do that. And for the youngsters it doesn't matter how many resources you have. If you don't know how to use them it will never be enough. We are a product of pre Google and pre internet era. Most of you even don't understand the challenges that we had once we did not have access to Google, Med nine, permed online. Still we managed. Millions of resources please research support country board there are only two ways of spreading light to be the candle or the mirror that reflects it.

I thank you all for your patience listening. If there any question, comments, please let me know. I'll share my presentation. Whosoever sends me an email and you can go and explore my YouTube channel as well. I am done Doctor Sadiq. Thank you very much. Thank you very much. Doctor Atul. Um so I think we very limited with the time. So what we going to do is I want to give, you know, one to two minutes for Dr. Murad Musa Khan to speak And then, we'll try to take on the questions that are mentioned in QAs section. So, Doctor Murad Muzar Khan, you know, if you can add, you, you know, your comments and just one to two minutes and then, I have a question for you about how to get in an international journal. This question was asked by Doctor Fazal Wahid. He is assistant assistant professor of ENT at Lady Reading Hospital, Peshawar. Thank you very much, Doctor Naveed and thank you, Dr. Farooq for a very excellent presentation. I enjoyed it. You've covered most of the things that really need to be said for research in Pakistan and I agree with almost everything you have said except perhaps one point. There is something called academic colonialism. Or imperialism. Whereby people from the western countries come and access the patients. Do studies and then publish as first author in the tag along a number of Pakistani authors. Ah behind that. The idea behind that may be noble that you increase a research capacity but it never happens. And are only give access to the pageant. So, I will not agree with you there. When you invite Apna to come and do studies because we have lots of pathology and lots of patients. I'll be very careful on that. The research agenda should always be set by the local people. Because the problems may be global but the solutions also has to be local. And for local problems you have to conduct the studies locally. So I would agree with you there. And all the other things you've said about what why do research? I would also add that you you need to produce new knowledge and you need to produce leave something for the next generation.

When I started my research in suicide I had only two small papers to go on. This is the pre internet era. Internet was just coming around at that time but I searched and searched and I only found two studies. One was in nineteen and one was in 1981. That is all. And I was hampered completely but now if anyone wants to pick up the ah of or get interested in suicide. So he he'll he or she will have you know scores of studies if not hundreds of studies to build on. So that I think that is very important for each one of us. One of the things that I would also like to point out. You talked to researcher. I totally agree with you. But we also have to really contextualise that. Can you just focus on research ethics without improving ethics generally in an institution. And in all institutions that you talked about the 184 medical colleges. There's no mention ethics. So you cannot produce a culture of research ethics and just expect people to become ethical researchers abiding by all the all the rules without a general improvement in in the ethics, in the in the whole institution. Which includes ah clinical ah effects it includes organisational effects. It includes ethics in teaching and everything else. So while you focus on research ethics also people should also focus on improving the general a student suffer from the lack of critical thinking. because our education system including in the medical colleges such that they not taught to question. Question seniors, question the unethical practices that are going on, the wrong practices. So, in research, you know, curiosity is the most important ingredient. You need to ask yourself, what, why, when, where, and how, and unfortunately we are not taught, taught those things. So, these, these are just of things I wanted to add to your excellent presentation.

Um an answer to your question doctor Naveer about how to publish an international journal. I think ah the way I started I was I was very curious, I wanted to publish ah but the way I started was really just writing, writing general articles, started with the school, college magazines, then writing from the newspaper, and then writing for local journals and very soon I found out the local journals were really of not of of the stand or the quality or the reviewer system that I would be satisfied. So I started doing that. You start small, you may collaborate with others, and then you build on that, and then you start publishing. Yes, replication may be one way to start doing it, someone has done maybe a study on certain things, case series in one country, you see if you can do it ah, in your country, this is exactly what I did. For, for my self-harm study, the very first study that I, that I publish so you start small and then you build on that. But behind that you've got to really read and read and read. For everything you that you produce you probably for one study that you get published. You will probably have to read hundreds of articles. So, start by reading as much as you can, inform yourself, educate yourself, go into it, look at what people have done and look at the articles critically, what they have missed out, why did they do this, why, why not this thing? Where did they get this information? Go into the references. So, first of all read as much as you can as you read questions will be generated, those questions will help you design your research questions, and then you start going and looking, looking at what is available there, I will totally agree with doctor Farooq that we have huge amount of pathology, huge amount of patients don't go for those randomized controlled trials, go for naturalistic studies, people coming through your doors, just study them. Just study their profile, gender differences, the background, the socioeconomic class and so on and case series, case report, you start with that and then you build on that and eventually you will.

I mean international journals is not something that is beyond anyone's reach. Anyone can do that. But but like I said read as much as you can. Ah then develop some questions. Look what is available. And then try and answer those questions. And of course like Doctor Farooq said you must get trained in research. And if institution doesn't do so and there are different ah different sources that you can ah can access to train yourself in research. Thanks very much. Thank you and I I think this is an really important discussion that is happening and that's how we generate our shared perspective by you know sharing different ah opinions. Ah Doctor Rathore there there is a question posted ah ah by a medical student ah and I'm just going to ask you this question. Ehm it is sort of person specific question. We are currently dealing with and you can also read that question. We are currently dealing with diabetic patient on adrenal replacement therapy. It is a cross-sectional study. Our sample size is sixty. Is that enough to make a mark. If you answer that and then you know I I'll ask the second section. You're muted, Dr. Atul. Sorry, gimmicks here. Uh can you hear me now? G, yes. Okay, so my first advice would be go and consult a bio statistician because they are the expert in calculating sample size. And obviously the sample size is calculated by a certain formula. First of all, you like determine or you select what kind of formula you are going to like use. So, in Pakistan, mostly, I've seen people using that online WHO sample size calculator. There are certain you know, sort of like parameter that you have to fill in and once you fill in those parameters and if the sample size comes out to be 60 and you can justify that 60 was the size that was appropriate to conduct its research. Obviously any good biomedical journalist went to accept that. But in some cases for example if the disease is very very common and your research is just an observational study then the expert or the peer review or even the editor might say that you know this disease is very prevalent.

So yes statistically you have come up with a very small sample size but clinically on ground it does not mean anything. So that's why I always say you know you need the input of an expert or may be a faculty member, supervisor that you know you might have technical skills but the person at the top might have those real life skills. And here she can tell you that whether these two things, this statistical thing and the real life clinical scenario, they do meet or not. So 60 might be a appropriate sample size depending on how do they present that or it might not be an appropriate size if the disease is very common. Or the peer review says, you know, we read a lot of simple size. So, I would say go and consult a bio statistician. And the second part of caution was that, you know, that, you know, this student is working with three other two other students, and, you know, one of the faculty might be an author on the paper, whether it would be disadvantage to Iraz. So, eras is an application, residency applications offer in US. It would not be disadvantaged, but again, you know, we all need to consider, or think about, you know, the, the, the, the contribution of each author in a paper. I, I think that was a point that Doctor was trying to make earlier, Now, Doctor Sayed Uzar, are you there? I see that you are muted, camera is off. So, I'm going to post this question to you. I'm going to go a little bit over time because it seems like people are interested. So, Doctor Guru Nawaz Khan asked, I'm a trainee in family medicine. How shall I be able to become a quality and standard research writer? Please guide me because we don't have such facility and training and maybe Doctor Rathore after Dr. Rosair, you can add on to this question and Doctor Rosette, if you want to introduce yourself, I that would be super helpful.

Yeah, so I am basically Toronto based and my specialty is healthcare management. So, that's a little bit different from this thing but I am part of this move since we started like two years ago. So, as I was mentioning and writing. So, we had a series of webinar on clinical research here on Apna Merit And many speaker, they presented a lot of stuff. So, that's very important, lot of free stuff, lot of training, resources, lot of places. So, have mentioned the ah link to the YouTube ah channel where you can find all the materials. So it's a in detail overview and in detail in detail submission about all the resources. So I think now with the internet and everything. So the resources and the money is not the question at all in these days. If you have a will you can find all the stuff even at any level. So as by mention by Doctor Farooq Azam. So, it's a great presentation and I think it's going to add a lot of value to the already existing resources which are available. So, anyone can go to the website and have a look to all the free material for the undergraduate level. You just need to have a good internet connection. Now, knowledge is not the domain to anybody, you know, or to the people who have a money, there is a huge depository. So, we can share with all the spend lot of resources, links they are free and they are available to everyone. Thank you very much. And thank you, Dr. Shahid, come to you and maybe Dr. Rathore, there is also in in a non-profit with name of Author Aid. They are doing a lot of writing courses. They are free of the cost and they do an excellent job in writing courses and in some other areas of research too. So, you can certainly, you know, look at them and see if that is a possibility. Doctor, did you want me to add something? Yeah Thank you, Sadiq. I think it, it was one of the best presentation in a long time that I have attended. Thank you, Dr. Rathore for that. So, one thing being with Apna Merritt for a long time, we did, in the beginning, focused more on education, medical education, lectures, seminars, and then later on, course is.

But we started ah about I think two, three years ago, focused more on research. And that's why we created a sub committee in Apna Marriott. Ah for research. And and now I'm I'm really happy that ah Sadiq, Dr. Sadiq, Naveed is sharing that and I am very hopeful that he will find his own way. But I just wanted to highlight ah what ah Doctor Muraj said that I I felt that there was a hint of saying that we really don't need international help. Um and we have to come up with an indigenous solution to the problem. Which is totally fine. Except that you sometimes have to see the track record. If the things are improving, if Doctor Rathore's presentation was about see how well we are doing in each and every aspect of research then that's really good. Then you really don't need anybody. But if the state of affair is such as doctor mentioned, then sometimes, you know, collaborating, not asking for help, not asking for a hand. But collaborating would not be a bad idea. So, I'll leave it up to Doctor Sadiq Naveed to find his way. You will see Doctor Sadiq that there will be some people who will be very welcoming in Pakistan like Doctor Rathore. For your effort to improve conditions ah in research everywhere. Including you know so collaboration and you will find some people who are not. So that's my one point. Second point to Doctor Rathore is that when you said about the incentive to research other than you know of course getting residency or getting promotion. Um have you had any view opinion about when you especially with, with your rehab background, when you bring in some instrument or medical device, that helps in rehab, and, and develop a research around that, can that be an incentive, and what is your opinion about that? Thank you very much, I think that would be absolutely, a great incentive, because, you know, because of globalization, most of us know what is happening all around the world.

But many time we do not have access to those kind of tools, those kind of machine and those kind of things that can actually may be make a positive difference. And we would love to do research. So at least in rehab, yes, we are always open to collaboration. And I am pretty sure for every specialty, there are certain things that we cannot arrange at our own in Pakistan. So, if Apna can like sponsor or support and bring that particular tool here, and that would, at one end, provide clinical care, and on the other hand, it would help generate clinical data. Good quality, local data that can be published in National Infessional Bitical Journal think that would be an excellent win win situation for everyone involved. And that just does from my side counts in an incentive. So thank you for the IDI. Thank you. I I I you know think you know that you know people in Pakistan knows about their situation the best and I think we can share our perspective on how to make things better but things needs to improve internally and we can just be a partner in their journey. Um so going back to I think the caution about resources, you know, the courses that, you know, I think, I forgot the name of the person, Dr. Ratur, do you want to add to that point, you know, what are some of the resources about research writing and all of that, so. Yeah, so thank you very much again, going back, so, again, you know, I did my, sort of like, medical school, late, late nineties, it was the time when was just starting off in Pakistan and had a very patchy internet. So I tell my colleagues that you in twenty twenty-one, 2022 sorry, you have multiple resources available at your fingertips. Obviously, this is not the time for that but just to quickly recap the resources. Again, one you ah you mentioned. Authorate is an excellent free resource. It's a global database where more than 22, 000 researcher from all around the world, they come together and try to help each other.

So, please go online authoraid. info. Excellent resource. There are many free writing courses available on Corsera and Adex. Again, free of cost. But if you want a certificate, you only have to pay 70 US dollar. So, what is better than getting trained in eight weeks from a faculty of Harvard Medical College on research and writing for free. What else do you need? You don't even leave to need to leave your institution, your even bedroom and you can do that. Then research your academy. com. So, Lziria in 2017, which means before 2017, this is not available. LZVL which is largest publishing group of scientific literature in the world launched a researcher academy specifically geared toward publication process of biomedical researchers. Researcher Academy. LZVA. com. It is an excellent resource which gives you a modular sort of ah ah training in research writing and the training is led by published authors, editors and peer review of the journals. Then ah ah this web of science the they have this ah again online academy free of cost where you can enroll and you can do all the courses. So, in summary, if anyone is really interested in becoming a better researcher, a better clinician, honestly, a lack of resources is not an excuse in the 21st century. Most of you have smart mobile smart phones, you have these handheld devices, you have internet connections, and you have laptops. So, please go online and train yourself. Training please. Be self sufficient and try to explore the resources that the world has actually put forward for your consumption. So, there are lot many resources if you need more list. Please email me share those resources with you as well. Thank you. Thank you very much and doctor Rathore, if you can share those resources with us and then we can share. Sure. With people. I'll do that. And for, for systematic reviews and meta analysis, Cochrane, if you go on the website, it has modules on systematic reviews and they are either very, you know, low in cost or free to people from middle and lower-income countries.

Yes. I would give a chance, so we'll take two more questions from the attendees, and then we'll wrap up this session. So Doctor had her hand raised, so I'm going to give her a chance to, Doctor Sumaya, Taslim, do you had a question, comment? Yeah, thank you. Very informative session. Um I have one concern because a lot of researchers have lack of resources for paying publication fee. The publication fees of international high impact factor journalist so much high. In one research groups and one Pakistani user here have very difficulties to pay these pieces. So, it you read the some research grant and some collaborative work ah collaboration to, to, to pay these research fees and ah we develop the certain research groups to one ah search ah researcher in Pakistan and multinational research group. It is the best research to publish to the ah in good impact factor journal. It is a beneficial to everyone. The low income group and high income countries. So I think we got your question. So I think what you are asking about is and Doctor Tour can and then I can add to is about publications in you know article processing charges that's what she's referring to. So can you add to that and then I'll I'll add my two cents on this. Okay so first thing is you know many journals yes they are charging a lot of money but then many journals ah you know they offer ah substantial waive