The growing gap between academics and reality
Digging out of the Academics-Reality Gap
I’m leaving academia after more than 13 years across 4 of the largest and most well-known institutions in America. The choice to part ways was not dramatic nor was it a particularly smooth process. In fact, I thought I would keep a part time relationship with my current academic employer and only found out via a 3-sentence email that the part time offer was rescinded during this summer. So, I can’t say it was entirely my decision to head a different direction. The reasons as explained to me for rescinding the offer are the same reasons I ultimately do not think academia will be able to contribute significantly to the digital medicine or digital therapeutics movement.
Specifically, as it was explained to me, if I stayed part-time in a purely clinical role, I would occupy a faculty position and prevent recruitment of someone else because multiple candidates could not split a single faculty position. For example, if there were 2 candidates who are a great fit and would like to each work half-time, they cannot be hired and the search continues to find a single full-time person to fill the role, even if this will be harder to find and leave a large gap during the interim, likely placing pressure on existing faculty. If I put myself in the position of the person making the decision to rescind the offer, I can appreciate the dilemma and I would probably make the same decision. However, this inability to expand the options or be creative is precisely why academic medicine cannot contribute to the digital medicine movement.
There is a growing gap between academics and reality. As we have seen this century, technology moves quickly and responds to an ever-changing landscape of demands from users. Academia just can’t move this quickly.
Information Dissemination in Medicine – The Gap
The publication cycle in academics is a good example of a broken system, especially as it pertains to medical technology research. Currently, if I complete a line of inquiry using health care data concerning digital health, I have to spend many hours formatting and preparing a manuscript according to a journal’s guidelines. I then submit and wait weeks to months for an editorial decision followed by comments from independent reviewers. I then have usually 1 month to provide my responses to questions/concerns. The comments from reviewers are generally limited in utility and this may stem from the reviewers being very busy volunteers. To be fair, there are reviewers who make helpful comments, but in my experience, this is less than half of the time. Then, it usually takes several more months for the paper to be published. Keep in mind, the paper can be rejected at any point in this process which leaves me with the difficult decision to choose another journal, give up, or openly publish it elsewhere. If I resubmit to another journal, there are usually painstaking formatting changes and other requirements before I can do so. By the time anything is published through these traditional channels, the work may be of limited or no use to others.
In a world where technology companies are turning around changes to software or new features in hours or days, how can we keep up with a grant and publication cycle this slow? When colleagues in technology do publish, they generally do it in open source journals or repositories immediately or at conferences to quickly disseminate findings.
How to Close the Gap
If you are working at the intersection of health and technology and either want or need to publish findings, it appears the best route would be to follow the lead of our colleagues in computer science and engineering. Look for conference you may like to present at and submit your findings there. This allows you to share information much close to the time you first have the results and simultaneously allows you to personally communicate and network with colleagues. A growing trend and likely the way of the future is posting your work on open repositories such as arxiv.org and following up with some media outreach to garner some attention. Medical journals will need to develop a new or additional publication process if they want to participate meaningfully in the healthcare technology research. These are concrete ways we can all help narrow the growing gap between academics and reality.