Summary

1. Introduction

Research drives science, and medical sciences are no exception. Evidence-based medicine enhances healthcare decisions [1]. Medical research shapes public health dialogue, emphasising the need for greater and targeted health investments. Scientific publications, as written documents of research findings, play a crucial role in disseminating outcomes within the scientific community. Furthermore, the publication of research is considered evidence of an institution’s research capacity and significantly influences university rankings and future funding prospects [2, 3].

In recent years, there has been a surge in scientific publications across all fields, including nephrology. This increase is attributable to new molecular discoveries, a rise in clinical trials and enhanced accessibility to publications through the efforts of various scientific societies and prominent journals [4, 5].

Despite the overall increase in research publications, there is a notable lack of representation from low- and middle-income countries (LMICs) and women in first or senior authorship roles. A study by Subhash Chander et al. reported that the median proportion of women in first and senior authorship positions across eleven prominent journals was 20.8% (interquartile range: 13.3%–25.3%) and 9.4% (8.6%–12.4%), respectively [6].

Promoting an inclusive and diverse research community is crucial. Bridging these gaps is imperative to study real-world health outcomes and promote universal healthcare delivery.

This study aims to investigate the obstacles perceived by nephrologists in writing scientific papers, as no data on this subject have been available to date. Identifying these obstacles and aids is essential, as only through this understanding can customised assistance be developed to enhance the writing process and promote a diverse research community.

2. Methodology

A questionnaire-based survey was developed to gather data and insights regarding challenges and limitations in scientific paper writing from an Indian perspective.

3. Results

We reached out to 534 nephrologists and nephrology fellows via WhatsApp and email, sharing the survey forms. Of these, 156 participants responded to the survey and completed it. The response rate for the survey was approximately 29.21%. The number of responses per question was 156 (100%). This survey, which included 156 practising nephrologists and fellows, revealed some key demographics. The majority fell within the 31–40 years age range (53.8%), with a mean age of 35.55 ± 8.91 years. Males made up the majority at 55.8%. 69.9% of practising nephrologists and 30.12% of nephrology fellows participated in the study. Most respondents (45.5%) practised in medical colleges/institutions, with only a small percentage (0.6%) focussing entirely on research. Most were from metropolitan cities (60.3%), and the average duration of practice in nephrology was 12.29 ± 9.12 years (Table 1). Thesis is a required component of nephrology training in India. Only 44.9% of the respondents published their thesis work in nephrology. 52.6% found case reports easy to write and publish, followed by retrospective observational studies (17.9%). Case–control studies and randomised control studies were the least preferred types of research. 38.5% had presented their research work as podium or poster presentations 2 to 5 times and 28.5% more than five times. Out of these presentations, the majority (72.4%) published only one research article (Table 2).

39.7% of the respondents shared that their articles were rejected atleast once before being accepted by another journal. 37.8% said they had to revise the article 2 to 5 times before it was accepted.

The study also delved into the effect of age on scientific paper writing, the results of which are depicted in Supporting Table 1. It was found that older nephrologists (> 50 years) had significantly higher numbers of poster/podium presentations (81.8% vs. 24.82%, p < 0.001) and publications (12.8% vs. 9.65%, p < 0.001) compared to younger groups.

Younger nephrologists, on the other hand, found funding for research (68.96% vs. 54.6%, p = 0.01), lack of knowledge in statistics (74.4% vs. 63.7%, p = 0.01), limited access to software for research analysis (65.1% vs. 54.6%, p = 0.04) and difficulty in literature review (51.1% vs. 9.1%, p = 0.007) as significant challenges in scientific paper writing compared to the older age group. Burnout was significantly higher among nephrologists between 20 and 30 years compared to those beyond 50 years (74.4% vs. 27.3%, p = 0.002). Clearly, the obstacles faced by the younger age group was higher than the older age group. This could be attributed to the longer career length of senior nephrologists (Supporting Table 1).

The challenges of paper writing with respect to the gender of the doctors were also studied; the results are shown in Supporting Table 2. Women doctors had significantly more podium/poster presentations compared to men (40.6% in women vs. 19.5% in men, p = 0.008); also they published more compared to men (18.8% in women vs. 8% in men, p = 0.036). Men found difficulty in framing research questions as a major challenge (40.1% in women vs. 48.3% in men, p = 0.02), while women expressed that lack of research interest was their major challenge (36.7% in women vs. 24.6% in men, p = 0.018) (Supporting Table 2).

4. Discussion

There are multiple challenges in healthcare delivery in the developing world. Enhancing research is one of the most effective ways of improving the status of health care in this resource constrained nations [12, 13]. Despite this, research continues to be a low priority in physicians in these countries as there are many barriers to research and scientific publishing. In a study from India, more than half of medical college faculty had not had any publications in a decade, starting in 2005 [14]. This survey tries to highlight some of the areas of concern.

One of the most significant concerns cited by 67.9% of the respondents in this survey was funding. The nonavailability of sufficient financial resources as greatest barrier to research activity has also been emphasised by Kabirpanthi, Gupta and Chavan [15]. Not only the financial support for high quality research is lacking (especially in noncommunicable diseases which are the major risk factors for chronic kidney disease) [16], but also funding for publications is becoming a major concern in the ‘open-access’ (OA) era. This in-turn creates more opportunity for ‘vanity presses’ [17–19] and also makes publishing extremely difficult for authors from India.

Astronomical APCs prohibit authors from the global south (LMICsin Africa, Latin America and parts of Asia) from publishing in prestigious journals with high impact factor [20, 21]. Many journals partially waive off APCs, still many LMICs remain ineligible to apply for these waivers [22]. Authors from India cannot apply for reduced APCs as they belong to a large economy, even though the per capita income is comparatively low. The unfortunate consequence of APCs is that many authors cannot afford the amount [23] and fall in the trap of publishing their work in predatory journals [24].

The observation that majority (70.5%) of the survey respondents felt that APCs were a huge expenditure underscores a critical barrier for researchers from LMICs. These charges disproportionately impact researchers with limited funding, paradoxically hindering the very goal of broad dissemination that OA aims to achieve. A deeper exploration into this issue includes the economic impact on researchers, the role of institutional and governmental support in subsidising these costs and innovative publishing models that circumvent the need for APCs.

Highlighting the need for policy changes and incorporation of collaborative funding models at national and international levels could offer viable solutions. The collaborative funding models pool funds from national or regional organisations and philanthropists to fund research projects. It can alleviate the challenges and ensure a more strategic approach to address the resource gaps and deficits in funding. It also expedites the research process and leads to novel discoveries [25].

On the other hand, the government could allocate more funds for research and development in the national budget providing scholarships and fellowships for aspiring researchers. The medical universities must seek to form collaborations with other institutions for monetary support. They could enter into membership agreements with certain publishers to minimise the subscription and publication fees for journals to make research more accessible for physicians from LMICs.

Such an expanded discussion would not only address the financial challenges but also propose actionable strategies, advocating for a more equitable scientific publishing landscape that enhances the visibility and impact of global research.

Another notable finding is that fellows in India do not publish their thesis. This is also similar to data from the first world, where the majority of the scientific presentations in meetings as abstracts are not published as original articles [26]. In Nigeria, lack of time because of clinical responsibilities was a major impediment [27]. In China, the students felt they needed inspiring mentors to guide them [28]. In the Arab states, the lack of equipment and infrastructure plays an important role [29, 30]. These barriers in various forms are also expressed in this survey.

Another important finding that came out of the survey is the fact that young women nephrologists are increasingly moving towards publishing their work. This is a very welcome trend as this is in contradiction to literature from rest of the world. A review of literature reveals that women scientists publish much less than their male counterparts do. Women have greater nonprofessional responsibilities, work in challenging work environments and often need help to break the glass ceiling. This is true across the spectrum of publications in science, not just in medicine. Nonprofessional responsibilities often attributed to women vary widely by culture, society and individual choices. Traditionally, these responsibilities have included a range of domestic and caregiving roles. Some common areas where women have often played a significant role are household management, childcare, elderly care, emotional support, community engagement and children’s education, though it is important to recognise that these roles are changing and that there is increasing recognition of the need for shared responsibilities between all genders [30, 31].

Women are less likely to be named as authors in a manuscript; their work less recognised and less likely to be credited as their work is not known [32]. They also have less patents compared to their male peers [33]. The most celebrated instance of women overlooked when it was due is the case of Ms Rosalind Franklin who was one of the scientists involved in elucidating the structure of the DNA. She was wrongfully denied her role, and it was only after her death the truth was known [34]. Women as first authors of manuscripts in high impact journals is also quite rare [35]. One of the reasons could be these high impact journals preferentially publish large randomised trials and women get less funding for such trials [36–38]. However, this trend is changing [39]. Hopefully this will manifest as more women clinicians will take up scientific writing and publish more often as this survey indicates. In India, women currently constitute 60% of nephrology fellows, indicating a significant shift in trends within the field [40].

Academic burnout is being increasingly encountered in Asian countries, across various specialties during residency programs and in professional practice. The negative impact of this condition overwhelms the ability of students and practitioners to cope with daily challenges and leads to emotional exhaustion. The balance between work–life expectations and personal accomplishments is threatened, thus compromising productivity at physical, mental and social levels [41].

Time management issues are the most frequently mentioned physical barriers. Academicians cited several reasons for these problems, including the inability to find time to write, procrastination, poor daily and long-term planning, inability to complete tasks during the day and sacrificing sleep.

This survey identifies several key challenges that frequently necessitate revisions in the scientific paper writing process. Faulty or unclear methodology is a primary issue, often leading to extensive revisions when reviewers request clarification or additional experiments. Additionally, many respondents reported a significant lack of knowledge in statistical analysis, resulting in errors and inappropriate use of statistics that require corrections to validate research findings. Language barriers also present a notable challenge, especially for nonnative English speakers, compelling revisions to enhance manuscript readability and coherence. Overall, these revisions are common across methodology, statistical analysis and language, with the extent of their impact varying based on the researcher’s background and the specific demands of the research.

To address the challenges in the evaluation process, several strategies are proposed such as reviewing the guidelines and scope of the journals, enhancing the text with images for better clarity, seeking advice from authors who have submitted to similar journals, preassessing the manuscript from a reviewer’s perspective, examining recent publications in the target journal and reaching out to the editor [43].

Challenges regarding knowledge of statistics and use of statistical softwares can be circumvented by conducting regular courses in scientific writing and incorporating the curriculum during residency or fellowship courses [44].

By systematically addressing each of these challenges and limitations, researchers can efficiently contribute to scientific writing process and enhance their productivity and the quality of their work.

The potential limitations of this study include the use of a nonvalidated survey tool. The data collected were based on self-reported measures, which can introduce biases such as social desirability bias or recall bias. This may affect the accuracy of the information regarding challenges and limitations experienced by the participants. Given the sensitive nature of some topics, such as financial constraints and personal perceptions of the impact of research, there might be underreporting of these issues. Participants may be reluctant to fully disclose their struggles in a survey, even if it is anonymous.

On the other hand, the fact that only 156 out of 534 participants responded to the survey shows that people are frequently hesitant to spend time answering the survey-based questionnaires. This is another limitation of survey-based research. Apart from being circulated through regional platforms like email or social media, the survey could have been officially distributed by the institutions themselves, which could have boosted the response rate.

5. Conclusion

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

M.S. conceptualised the idea, collected data, performed statistics and wrote the paper. A.U. collected data and wrote the paper. S.R. collected data and wrote the paper, U.A. wrote the paper and A.R.C. reviewed the paper. All authors read and approved the final version of the manuscript.

Funding

No funding was received for this manuscript

Supporting Information

Supporting Table 1: challenges in paper scripting in relation to age (in years) of doctors studied.

Supporting Table 2: challenges in paper scripting in relation to gender of doctors studied.