Hi, everyone. My name is Abhishek Pardosh, and I'm a third year pulmonary and critical care medicine fellow at Cleveland Clinic. Welcome to Crosstalk for SCCM 2022. I'm joined today by Dr. Professor Tim Buckman from Emory and Dr. Robert Tasker from Boston and Howard. Dr. Buckman is the editor-in-chief for SCCM and Dr. Tasker is the editor-in-chief for the Pediatric SCCM Journal. So the purpose of this particular Crosstalk is to kind of get our audience familiar with what's new and what's coming in the coming years for both the pediatric and the adult SCCM journals. With that, Dr. Buckman, please tell me what's happening and what's the plan for the next year, what's new in SCCM? Well, while there's so many things for the critical care medicine and critical care explorations journal, so many things we can tell you about what's coming. One of the important changes that's coming for authors and contributors is a new set of instructions for authors. So we hope that those who are submitting, planning to submit journals will have a look at those long before they begin organizing their work. One of the most important things is clarification to align ourselves with emerging international standards as to who's an author and who's a contributor. Now, contributors under the credit taxonomy can have up to 14 different roles in the research and the writing of a manuscript. Authors are fairly clearly defined by the International Committee of Medical Journal Editors as to having specific responsibilities in the preparation of the manuscript layered on top of the work itself. So with the sweeping change in instructions to authors, and in many ways aligning ourselves with the path breaking work that Dr. Tasker has done over at Pediatric Critical Care Medicine, we hope to have a very harmonized approach to the process of submission across the entire family of journals that are official journals of the Society of Critical Care Medicine. That's great. And Dr. Tasker, anything to add from your end? Yes. You know, it's my second year at PCCM, and we've brought about quite a few changes and want to see some of the new sections that we brought in getting consolidated. And my idea was that some of these things would take about three years. I think what I'm really pleased about is that we're getting the three journals aligned. So Tim will have the instructions for authors, and we will adopt those probably later in the year than CCM and CCE take them on. And with slight modifications, hopefully things will look similar across the three journals. Really excited about our use of boxes. So research in context that goes in the introduction and what this study means or at the bedside that goes in the discussion. It's been slow to be adopted by authors, and some persist in just not wanting to be interested in that. But we're getting there, and authors are beginning to incorporate this in their first submission. So pleased about that. So, you know, lots of things that are happening. I'm sure that we will talk about some of the other things later on in this discussion. Over at Critical Care Medicine and Critical Care Explorations, we're following Dr. Tasker's lead. We think that providing information as to the key points, what this study tells us in bite-sized fashion, is increasingly important in this era of social media, digital communications, and the workload that all of our constituent readers face. They want to get a very fast summary, if you will, and at a glance look at what the report is about, so they can make an informed decision as to how deeply they want to dwell into that report. It is both living the report and delving deeper into it that makes the difference to our readers. Whether it is through these key points, or what's the impact box, or the abstract, or the study itself. And Dr. Tasker is working on some very innovative things to make sure that the format with which stories are presented match the reader's needs. Robert, do you want to talk a little bit about some of your innovation over there? So, I think we've done a couple of things. One is the structured clinical report. You know, the structured abstract is getting quite old now, and it's changing. Journals are talking about structured discussion. Something that I learned a long while ago was actually structuring the whole article into two paragraphs for the introduction, five for the methods, five for the results, seven for the discussion, or two, seven, seven, five. If you're a reader, you know exactly what should be in each paragraph, and you can rapidly read an article in about five minutes and work out whether or not this is something that you should persist with. We're going one step further than that, and I think this is what Tim is alluding to. We're going to beta test the idea of an audio version of the journal. Someone's just going to read excerpts and sections, so whilst you're on your exercise bike, walking to work, or driving, you can be listening to content and then making a mental note, I've got to go back and look at that article. So, you know, it doesn't really affect me. I like to sit and read something, but I know that many people, if they can't get it in their earbuds, it's not going to be sort of focused on at all. So we're trying to adopt and adapt, and we'll beta test it. If it's a flop, it's a flop. If it works, it may well spread to the other journals. And we have some enthusiastic volunteers who are going to be reading, and I suspect if this takes momentum, then we'll be looking for more readers. No, I think that's fascinating, Dr. Tasker, because I can tell you, like having talked to a lot of my colleagues, that is actually something that people were looking for. What are the sources that latest articles can be heard rather than just sit down and read, especially for trainees, as you can imagine, with a busy life, they want the best of it, potentially that while they're exercising, while they're driving, they can actually hear it. So it truly is innovative and will be well received. That creates a need for people who can read smoothly in a nice FM radio voice. So start practicing, because we'll be sure to call on you. I did want to share a historic note. Robert and I, this is totally unrehearsed, but Robert might be interested to know when structured abstracts first appeared in official SCCM journals. It turns out they were brought to Critical Care Medicine when Bart Chernow, our endocrinologist, was editor-in-chief in the early 1990s. So we're very excited about the opportunity to talk about the history of the Critical Care Medicine journals. There's going to be an entire series on the history of Critical Care Medicine and by extension, Pediatric Critical Care Medicine, the first 50 years of the journals that will become part of the series that will run in Critical Care Medicine in 2023. So by the time we get together again, those articles will already be coming out. So stay tuned. I can still remember a teaching session that Bart Chernow gave me when I was a fellow at the Johns Hopkins in the early 1990s, and it was to do with calcium and magnesium metabolism. Those were Bart's favorite topics. I'll be sure to remember him to you when I speak to him next. Nice. Actually, I had a follow-up question regarding the audio component of the journal now. With the growing number of reviewers that you will need, especially with the critical care exploration and the audio component of it that Dr. Tasker is going to beta test, how are you going to recruit more reviewers and how can people get engaged into the early review process? What a great question. I'm going to give that one to Robert. Well, both Tim and I work with Paul Keciah. He is one of the senior associate editors on pediatric critical care medicine and is one of the senior editors on critical care explorations. And he's been instrumental in gathering together a group who have formed what is called a reviewer's school or a reviewer's academy. And the idea is to recruit from SCCM membership people who are interested in reviewing for our journals. At this point, I'll hand over to Tim because Tim has developed an innovative structure in terms of progress through our family of journals. So, the first thing that probably should occur is to have fellows and trainees at all levels, for that matter, all the way down to the residency, identify with their trainers, their mentors, that they're interested in the review process. It starts with journal clubs. Journal clubs are, in fact, a huge opportunity, not just to learn the science, but also to review the thinking and the writing that went into the manuscript that's the topic of this week's discussion. Once people identify that activity as something they're looking forward to doing, the reviewer academy that Dr. Tasker spoke of is going to be a great next step. Now, Paul is the leader of the group, but we have widespread representation, not just across the journals, but across the diversity and inclusiveness of our younger mentors who are in our editorial board ranks. Several of them have already volunteered to do one-on-one mentorship, and we had planned, had this been a face-to-face meeting, to have face-to-face sessions on how to look at a paper, how to do a review. That opportunity will resurface in another face-to-face meeting in the future. We hope it will happen in New Orleans or thereafter. We'll just have to see how the program committee works through the questions. But we're going to have a train-the-learner and then train-the-trainer sessions to help people identify what goes into a high-quality article, and importantly, how to help authors put their best foot forward. Because once you learn to review, you become a much better author. And this leads to the question of how should authors respond when they get an initial rejection, or even after they've tried to revise a manuscript and they still come back with a, you know, this is not for critical care medicine or pediatric critical care medicine. Now, one of the first things that Dr. Tasker and I recommend is to take a deep breath, sit down, and read the letter that it should receive. The reason is that increasingly, Dr. Tasker and I are choosing to help the author identify the best possible venue for his or her paper and their team of authors. We cannot accommodate, we can't nearly accommodate all of the submissions that are received in critical care medicine and pediatric critical care medicine. We have an embarrassment of riches, if you will, very high quality submissions coming into both journals. It's one of the reasons why he and I work so closely together in deciding which articles should be referred over to critical care explorations. Understand that a decline at critical care medicine or pediatric critical care medicine doesn't mean necessarily that it's unsuitable for an official SCCM journal, but we are often redirecting the author team to critical care explorations. Little known fact, Dr. Tasker is my senior associate editor at critical care explorations, where I'm editor in chief, and it is precisely because he and I want to help authors get their work published, if appropriate, in an official SCCM journal. Robert? Yeah, you know, I agree with all of those points. I think we also, what we've done at PCCM is that we've also provided materials that help authors in terms of their structuring of their report and trying to sort of second guess what a reviewer is going to do, even before they've submitted. So, we've recommended going to the Equator website and checking out guidance on writing material and how things should be presented. So, if your report is about diagnostic testing, you absolutely must look at the STARD guidance. If you've done a systematic review, yes, it's fine to have followed the PRISMA guidelines, but actually what puts your report one notch higher is to have had the report registered or the work registered with Prospero, who give you a pre sort of evaluation and also tell you whether or not someone else is already doing this. We've published in our PCCM notes section how to do a scoping review, how to do propensity score analysis. Tim has published in Critical Care Medicine the prediction modelling. So, there's so much in the journal. So, you know, my one recommendation, I think, to authors would be be a reader of the journal that you want to submit to. Know its narrative, know the type of material it takes, and the standard that is expected. So, knowing the audience becomes a very important part of the process. Often Robert and I get articles that were turned down elsewhere and simply relabeled for our journals, without clearly understanding and being familiar with the guidance that we've provided in both of the journals as to how to best orient a report for our readership. Both of us think constantly about what our readers want to see in the next issue of the journal. It's our priority. That makes sense, and I'm actually a beneficiary of that feedback. Last year, we submitted our study initially to Critical Care Medicine, and actually, Dr. Bookman, it was your response that we actually took into consideration and actually submitted with a revision to Critical Care Exploration on COVID-19 and cardiac arrest, and it's out there, and it is well-received, and we have received good feedback on that. So, the editor's role truly is really helpful if applied appropriately by the authors for resubmission. That totally makes sense. On a follow-up question regarding other aspects of what authors can do, many people kind of shy away from reaching out to editors if they are worried about, is this a right venue for us or not? Is this something that you encourage, or is this frowned upon? Because most people will not have the opportunity to actually talk to an editor-in-chief like this. So, what do you think? So, I'll start with that question and then let Robert pick it up. If you go to our submission sites for Critical Care Medicine and Critical Care Explorations, there's a big banner there, and the banner says, if you're not sure about your article before you go through the long and arduous process of submission. I know the process because I submit articles to my journals. They're handled by others who are appointed as acting editor-in-chief. I know how hard it is. Send an email. Tell us a little bit, 100, 150 words about the idea that you have, the project that you're writing up, the article that you want to submit, and we can give you some fairly early feedback as to how it will be received. We don't want authors to waste any more time. Time is valuable on submissions that are not going to make it to an initial stage of review. So, take advantage of that. Robert and I get inquiries every day. Is this a good fit for your journal? And we're happy to take three minutes or five minutes there to read your note, give you a little bit of feedback as to where we think it's best positioned. So, the author team has the greatest chance of saying, yep, we're sending this out for review and giving you the opportunity to have this evaluated for publication in the journals. That sounds great. And actually, the reason I asked is because people think, is it inappropriate, even though it says on the website and it says that the process should be used, but like, am I wasting editor-in-chief's time? So, but thanks for clarifying that. And I'm sure people who are listening to it will probably take advantage of it and you will have more emails to look through. I would much rather work with an editor, with direction, work with an author and author team for five minutes before they go through the process and help them envision where the right venue for their work might be. That's perfect. Another question that came up recently. Before we go on, Robert, you want to speak a little bit about PCCM on that point? Yeah, I think it falls into two or three camps. One, we're certainly approachable and the sort of brief email describing what it is you want to do, certainly look at that and we'll get, you know, give an honest answer back. Sometimes I get an email from a group. So, within pediatrics, there's the acute, pediatric acute lung injury and sepsis sort of group. They actually do much more than that, but often one of their subsections writes, you know, would you be interested in what we've got to say about ECMO in stem cell transplant patients, for example, because they want to provide a position statement or some sort of review. And so, I'll convert that into a special article. I say don't follow any particular format, just send in what it is that you think you want to say and we can work with that. So, I call that sort of editor commissioned material. And those often end up as either special articles or special reports. Then we have other material where a group is interested in providing a concise clinical science review or a concise clinical physiology review. And again, I'm expecting to be approached by people who are at the intersection of either physiology and clinical care or basic science and clinical care and will give me a brief review. The idea is stolen from the New England Journal. If you know those brief reviews that are usually two pages, one page has a beautiful color illustration and we've recently had one on COVID-19 and MIS-C from a couple of the SCCM subsections and it's skyrocketed in terms of altmetric even before it was published. So, well received by readers. Then the third thing is just a little word of caution as an author. You've got to tell us in your covering letter why you are excited by this work. Why is it that this is important for the journal? Why is it relevant for the journal and for the audience that we serve? And please write the covering letter specific for the journal. I come across letters to the editor that are to a completely different journal but it's your covering letter. That doesn't disqualify and it doesn't make me look badly at the article but, you know, go through the effort of shaping a covering letter that's specific to PCCM or CCM or CCE because we do read them or I, you know, we do read them. The reason that it's important to shape the letter is that if you haven't shaped the letter we wonder if you've shaped the article for our readers. And that brings me to a few things that are so important to authors when Robert or I gets the manuscript into our queue. One of the most challenging things that we do is figure out, try to figure out if the manuscript clearly communicates a set of ideas, findings, and reasoning to our readers. The quality of the grammar, usage, syntax, the brevity of the report, the clarity, and especially the importance of proofreading cannot be overstated. Manuscripts are documents and documents are either going to be read and savored or they're going to be parked in a pile and never further examined. Editors respond to well-organized writing, readers respond to well-organized writing, and perhaps most importantly reviewers respond to well-organized writing. So, if there's one overarching tip that I can give to individuals and teams submitting manuscripts to the journals, before you push that submit button, hit save as draft, come back to it in a couple of days, give it to a friendly colleague who is skilled in submission and the organization and structure of scientific English, ask them to go over with a green eye shade and a red pencil, give advice. Nearly every article that we see on the first go-around could have been improved had the authors followed that simple advice of, you've worked on this for three months, six months, a year, take the extra 24-48 hours to make sure your submission is as perfect as it can be. It does make a difference when it crosses our desk. Great, great points Dr. Bookman and Dr. Tasker. I think these are valuable advice to anyone who's an experienced publisher in terms of many, many articles versus someone who's starting out so well taken. Another component that I wanted to ask you is the audio component of the journal is very exciting, as you have alluded to Dr. Tasker, you're doing beta testing. What about the podcast accompanied component to this? I'm not saying every single article that gets published should have an accompanying podcast where the author or the editor kind of interviews and discusses some component of it, but have we thought about this and are there opportunities to explore that? Robert, do you want to begin? Yes, so Margaret Parker does do podcasts with authors. It's somewhere between two and four per year for pediatric critical care medicine. It's a lot of organization and coordination and effort. They're great things and, you know, it's just a question of people's time, organizing it. You know, there are many different types of podcasts, they could be contemporary podcasts. You probably don't or may not be aware that Martin Tobin at the Blue Journal brought in this thing called tell it like it was. And the one that really impressed me was the sort of severing house lumbar puncture studies at Altitude getting CSF and making them talk about well how did you do the lumbar puncture because your fingers were cold and what was it like the needles weren't like modern needles. So you know podcasts like that about tell it like it was in terms of critical care and to be on the back of Tim's 50 years of critical care to me sounds you know that's that's an opportunity waiting to happen to see all of those and hear about all of those great articles. But it's a lot of effort and time which is why I've gone for the fairly simple thing let's just have someone read this stuff first and excerpts and get people interested and I'm sure if it gains momentum and members and subscribers if they like it then it's sort of it's people power. These other things will follow. We've always had a history of podcasts during my tenure as editor-in-chief of critical care medicine. There's a fair number of them as Robert points out they take time to organize and produce so we pay close attention to how often they're actually downloaded and used and we do respond to the level of engagement that we get. But more generally all of the official SCCM journals have tried to keep pace with the times and use as many different platforms and delivery systems for use of content. Begins with our social media editors who try very hard to get a bite-sized introduction into every article. Our visual editors who create those outstanding infographics. The delivery of the written content in a platform agnostic fashion so can be looked at on a conventional desktop, laptop, tablet, smartphone. We don't have any implantable devices yet but we're getting there. Robert is trying this experiment with audible articles and will continue to evolve and innovate to try to meet the need of our readers. Another aspect that comes up when we discuss during our fellows meetings or when we're interacting with residents or even patients for example is the humanism concept and especially in critical care like how important that aspect is. Are we thinking of special editions or opportunities where patients can co-author some of their perspective with the physician or the treating team because there is a gap there that hasn't been looked at. Especially pandemic has created this void where patients need to express what they have gone through. Families of critical ill patients and survivors. Have you thought about potentially looking into that as well? Robert I'll let you start. So I've always been keen on narratives which I call narrative essays and one day I saw a piece that one of my critical care colleagues Daniel de Corsi had written and it was in one of the JAMA network journals and I thought to myself well you know why don't we have that in PCCN. So last year we started the narrative section and I have two accomplished narrative authors who've written for various journals. Daniel de Corsi and Winnie Morrison. Daniel is from Boston Children's Hospital. Winnie is from Children's Hospital of Philadelphia. Both pediatric intensivists and again we just tested the water and it's been amazing. People have submitted work. It's gone through rigorous review. Unfortunately we've had to reject work but we've accepted work and I don't anticipate them being cited but they're read. They're noted on altmetric. People are looking at them and actually yeah in my April editorial I have no shares in this book but this is a whole book of narratives written by intensivists about their experiences. We've got one that is coming that's written by a parent and respiratory therapist about their experience of being on the other side of the bed. Being you know being in the critical care as opposed to working in critical care. So it certainly hit a need and I'm keen to move forward. Other journals have done the same thing. You'll have seen intensive care medicine do this. JAMA do this. NEJM sort of does something a bit like this in their front pages. Then the thing that I'm contemplating at the moment is what about poetry and I just don't know quite yet. I do know that medical students now have a whole curriculum on arts and humanities and it's a theme that runs through their education and it's actually being writing poetry and writing narrative essays is actually being part of some pediatric critical care fellowship programs in terms of helping fellows better reflect on what it is they're seeing and what it is they're doing and just being able to express those experiences. But I think it extends to the whole critical care community of professionals that are involved. So yes there is scope. I think that what ultimately we will do is bundle all of these together that are published and make them collections that readers and subscribers can have access to together. So it's an early start and I think we're up to nine now essays that have been published and they're short. They've got to be short and they've got to be to the point and you've got to have good people handling them. I read them of course and sort of give a final decision on them but I've had experts involved. So you know it is something that is developed in the core curriculum in medical schools and also nursing programs so we have to respond. We've published a number of commentaries and critical care explorations as well. I share Robert's philosophy that these can be appropriate but there are a couple of points worth emphasizing. As Dr. Tasker said these are subject to peer review. This is not sort of an open blank page where anyone can submit anything. We have far more submissions than we have space to publish them so that we are very careful to adhere to the process of peer review. The second thing is that when writing this sort of narrative the quality of the writing rises substantially as a determinant of whether an article will reach review or publication. I can't emphasize enough the importance of the rigors that we all practiced in secondary school of drafting, revision, seeking local critique, rewriting, polishing, proofreading all prior to the submission process. This is meant to be the highest quality writing and if the quality of the writing doesn't match the quality of the underlying thought it is likely to be rejected. So that all of those who are considering submitting this type of work I strongly recommend doubling down and really working to hone the piece using the craft of writing. Okay thanks Dr. Buckman and Dr. Tasker. Those are very valuable advice and I think most people have thoughts and they want to express and but as you highlighted it's the quality of writing that other people can actually enjoy reading that experience is meaningful. You know we have only 45 minutes but if you have any other thoughts that I have not explored yet please share with us and our audience. Robert I'll let you take that one first. I would challenge people to read PCCM. I think it's a great journal and it's actually for readers. Yes I coordinate researchers and writers and professional groups in what they submit and do but ultimately it's for the readers and ultimately I hope it impacts clinical practice and the way people go about their practice. So you know one in four of all papers published to do with the field of pediatric critical care medicine are published in PCCM so what more efficient process could you have that actually have the journal on your front door because it saves a lot of effort and if there is stuff that we've not published or not bringing to light to readers just get in contact with me and we will find a commentary on that topic. We publish for readers we also publish for authors and matching those two is an ongoing challenge for editors of every professional journal. I urge as Robert has urged potential authors to read the journal to immerse themselves in it to understand what the contemporary information is we think is important enough to show up on a doorstep whether it be a physical doorstep or an electronic one. We recommend that authors and readers especially authors ask themselves the following questions. Is what I'm reading and writing novel? Is it generalizable beyond the confines of my own institution? Is it going to change the way people think and practice the art and science of critical care and medicine? Have I focused on rigor and logic in starting with clear hypotheses and making inferences and coming to conclusions? Is this the right venue? Is this the perfect medium in which to communicate my thoughts and my findings? We want readers to find joy in what they read. We want authors to find joy in what they write and by thinking through these questions both of those communities will be served and as editors we actually mean what we say when we say to our community send us your best work. Let us help you make it better. We want to see it in the pages of an official journal of the Society of Critical Care Medicine. Thank you Dr. Buchman and Dr. Tasker. This was great. I learned a lot and I'm sure anyone who will listen and watch this crosstalk will benefit from the experience and the wisdom of the editors-in-chief. So I appreciate your time. Thank you so much. Thank you so much. Good luck to you.

SCCM 2022

journal developments

instructions for authors

boxes in articles

audio version

narratives in journals

humanism in critical care

well-organized manuscripts