ABSTRACT
The coronavirus disease-2019 (COVID-19) pandemic since its inception, has significantly impacted the academic activities of medical doctors. The decrease in physicians’ workload and the urge to share new knowledge about the new disorder caused medical doctors to write and publish academic papers rapidly. We investigated the effects of the pandemic on the academic publishing behavior of dermatologists in Turkey.
The study was conducted through a PubMed search using the keywords “Dermatology Turkey". Search limits were set for 2017- 2019 for the pre-pandemic period and 2020-2022 for the post-pandemic era. Irrelevant articles were manually excluded. The publication year, type and subject of publication, whether the study was multicenter or multidisciplinary, and the journal were noted for each paper. Data obtained were analyzed using the IBM SPSS Statistics 25 package program.
The search revealed 986 and 1420 articles for the pre- and post-pandemic periods, respectively. The most published subjects were drugs and drug eruptions before the pandemic and COVID-19 after the pandemic. An increase in the ratio of “letters to editors” and in multicenter studies was noted in the post-pandemic era. The distribution among the journals of publication changed strikingly, and 35.8% of papers were published in only two journals after the pandemic.
There were significant changes in the publishing behavior of Turkish dermatologists during the pandemic. We believe that this study is important as a demonstration of the academic behaviors of dermatologists and a guide for young dermatologists who wish to publish.
INTRODUCTION
The coronavirus disease-2019 (COVID-19) pandemic, which started at the end of the year 2019, led to many changes in all areas of life, including the academic activities of medical doctors. The restrictions on the number of patients seen at outpatient clinics at the beginning of the pandemic caused a decrease in the clinical workload of physicians. Additionally, academic physicians were eager to share the findings and data they obtained about the new disease, and many scientific journals and publishers promoted articles about COVID-19 by offering fast-track and open-access publishing for these papers.1 This led to a substantial change in the academic productivity of physicians worldwide and more published articles.
In this study, we aimed to investigate the effects of the COVID-19 pandemic on the academic behavior of Turkish dermatologists, namely the changes in the number and types of scientific papers and their contents.
MATERIALS AND METHODS
Scientific dermatology publications from Turkey were evaluated in two groups: pre-pandemic for the last three years before the onset of the COVID-19 pandemic and post-pandemic for the period after the pandemic started. Only articles published in PubMed were included in this study. A PubMed search was conducted for the keywords “Dermatology Turkey” on August 5, 2022. Search restrictions were set for papers published between 2017 and 2019 for the pre-pandemic period and 2020-2022 for the post-pandemic period. The papers from 2022 were included until August. The listed articles were manually selected to include at least one dermatologist from Turkey. The dataset was constructed to include the year of publication, a type of publication, subject, status of being multicenter and multidisciplinary, and journal name. The impact factors of the journals were noted. For statistical analysis, the journals that published less than ten dermatology publications from Turkey were grouped under the title “other”. Papers published before 2017 and after the 5th August 2022, lacking a dermatologist from Turkey among authors and not indexed in PubMed, were excluded from the study. The subject groups are depicted in Table 1.
Statistical analysis
Data were analyzed using the IBM SPSS Statistics 25 package program. Descriptive statistics were given in terms of frequency and percentage, whereas comparative statistics between pre- and post-pandemic publications were conducted using the chi-square test. Confidence level was determined as 95%, and P values 0.05 were accepted as statistically significant.
RESULTS
The PubMed search resulted in 1265 papers for the pre-pandemic and 1627 papers for the post-pandemic era. After manually excluding articles that did not meet the inclusion criteria, the pre- and post-pandemic groups included 986 and 1420 articles, respectively. An increase in the number of publications after the pandemic started was noticed (Figure 1).
The dermatology subjects with the highest numbers of publications were drugs and drug reactions (10.4%), psoriasis (9.3%), and connective tissue disorders/vasculitides (7.9%) in the pre-pandemic period. During the pandemic period, the most frequent subjects were COVID-19 (13.94%), psoriasis (8.59%), drugs and drug reactions (7%), and connective tissue disorders/vasculitides coming in the 4th place (5.7%) (Table 1). The most frequently published subjects significantly differed between the pre- and post-pandemic groups (P = 0.001).
Clinical study was the most frequent type of study published in both the pre- and post-pandemic periods (51.12% and 48.59%, respectively), followed by case reports in the pre-pandemic period (32.76%) and letters to editors in the post-pandemic period (32.76%) (Figure 2). The publication types differed significantly between the pre- and post-pandemic periods (P < 0.001).
Most of the studies published in both pre- and post-pandemic periods were conducted in a single center (64% and 56.6%, respectively). National and international multicenter study frequencies significantly increased during the pandemic (P = 0.001) (Figure 3). While most published studies were multidisciplinary during both periods, the frequency of multidisciplinary studies significantly decreased in the post-pandemic era (P = 0.003) (Figure 4).
Two hundred sixty-two journals published papers from the dermatology departments in Turkey before the pandemic. This number was 293 for the post-pandemic era. For the pre-pandemic period, the three journals with the highest number of publications from Turkish dermatologists were Dermatologic Therapy, Cutaneous and Ocular Toxicology, and Postepy Dermatologii I Alergologii. After the pandemic started, the highest number of papers were published in Dermatologic Therapy, Journal of Cosmetic Dermatology, and International Journal of Dermatology (Table 2). The distribution of journals was significantly different between the pre- and post-pandemic groups (P < 0.001). The distribution of the article subjects of the most popular journal (Dermatologic Therapy) (Table 3) was compared with that of the Indian Journal of Dermatology, Venereology and Leprology, a journal in which the percentage of articles from Turkish dermatologists had decreased in the post-pandemic era. While 28.21% of reports from Turkey published in Dermatologic Therapy were on COVID-19, there were no papers on COVID-19 in the Indian Journal of Dermatology, Venereology and Leprology, and a statistically significant difference was found (P = 0.003).
DISCUSSION
In this study, we evaluated the change in publication patterns of Turkish dermatologists throughout the COVID-19 pandemic. There has been a striking increase in the number of papers published by Turkish dermatologists at the beginning of the pandemic. This increase is arguably caused by the changes in the working conditions of physicians. In April 2020, the number of patients seen daily in outpatient clinics was dramatically decreased by the Ministry of Health to decrease circulation in hospitals and dedicate health services to the care of patients with COVID-19. Inpatient clinics considered less “busy” and less “urgent”, among which were dermatology clinics, were shut down and replaced by COVID-19 wards. Many physicians, including dermatologists, were appointed to the COVID-19 clinics, where the healthcare personnel worked in shifts of 24 h followed by 48 to 72 hours’ off time to avoid contamination and exhaustion. There were also nationwide lockdowns, so people, including physicians, were at home without much social interaction. All these factors contributed to an ample amount of free time for Turkish physicians, who, under normal conditions, work very hard and see an average of 70 patients per day. Additionally, COVID-19 was a new disease, and medical doctors around the world, including those from Turkey, started to conduct research about this disease and publish their findings promptly to elucidate the clinical characteristics and pathophysiology of COVID-19.
The cut-off date for the post-pandemic period was set as August 2022, since in April 2022, the pandemic conditions in Turkey were put to an end entirely, including the shutting down of COVID-19 clinics at hospitals and the end of the obligation to wear a mask in public places.2 Thus, we included three more months after this date to allow time for already submitted articles to be published.
As expected, the “hot topic” during the pandemic period was COVID-19; although it is not a primarily dermatologic disease, Turkish dermatologists seem to have published considerably on this subject, mainly about the cutaneous findings of COVID-19 and cutaneous drug reactions caused by COVID-19 treatment. Interestingly, the frequency of letters increased remarkably and replaced case reports as the second most common type of publication, following clinical research articles. This may partially be caused by the publishing policy of journals, i.e., removing case reports from their article types and accepting case presentations only in letter forms. The rapid publication process, which was especially important during the pandemic due to an increased amount of new data about the new disease, may be another reason for the authors to prefer letters over case reports.
Another remarkable finding is the low percentage of pre-clinical research among other article types by Turkish dermatologists. Although this percentage somewhat increased during the pandemic, it was still very low. Today, the general approach to advances in medicine involves “bench to bedside,” and we believe that increased efforts in pre-clinical research in the field of dermatology would allow Turkish dermatologists to make better and more relevant contributions to the literature.
One of our most striking findings was that in the post-pandemic period, 35.8% of all articles from Turkish dermatologists were published in only two journals, Dermatologic Therapy and Journal of Cosmetic Dermatology. This is indeed an astonishing finding worth considering. We have a few opinions on why this trend occurred. First, academicians from Turkey have a hard time publishing in general, probably partly because of the quality of papers (due to language challenges since English is not our primary language, low economic sources to produce high-impact scientific research, and time limitations due to high patient numbers seen per clinic day, enforced by the government healthcare system policies). Some journals and editors may be biased or prejudiced against papers from Turkey. Therefore, a Turkish physician-researcher tends to look for journals that have previously published material from Turkey before submitting their work. Thus, a journal that has published articles from Turkey has a higher probability of receiving more and more submissions from Turkey. Second, many journals changed their publishing policies during the COVID-19 pandemic, such as quickening peer review procedures and publishing COVID-19-related papers with early and free access options. The journals that were favored by Turkish dermatologists were two of those that changed their publishing policies. Early and free access to articles means earlier and more citations and views, leading to a higher preference by authors for such journals. To prove this hypothesis, we compared Dermatologic Therapy, which comprised 19.3% of the articles produced by Turkish dermatologists in the post-pandemic era, with a journal that had decreased popularity among Turkish dermatologists (Indian Journal of Dermatology, Venereology and Leprology). None of the publications by the latter journal was about COVID-19, the hot topic of the era. Unlike many other scientific journals, the Indian Journal of Dermatology, Venereology and Leprology did not change its peer-review and publication policy during the pandemic because of the fear of publishing articles of low scientific value or containing misleading information about the newly emerging disease.3 As of December 2022, both Dermatologic Therapy and the Journal of Cosmetic Dermatology became fully open access, requiring article processing charges from authors. Therefore, we predict that another study conducted within two or three years may demonstrate a substantial decrease in the popularity of these journals among Turkish dermatologists.
Study limitations
There are a few limitations to this study. First, this was an observational study, and the pre- and post-pandemic groups of publications did not encompass the same amount of time. Although we allowed three more months after the cessation of pandemic conditions in Turkey, there may still be articles that have been submitted but not yet published. Many journals allowed fast-track publishing for COVID-19-related studies, thus withholding studies on other subjects, which may have been the reason for the high percentage of COVID-19-related articles.
CONCLUSION
Overall, the COVID-19 pandemic appears to have increased the academic productivity of Turkish dermatologists. The scientific publishing behaviors of dermatologists in Turkey remarkably changed during the pandemic, especially in terms of publication numbers, journals of publication, article types, and subjects of articles. Although COVID-19 is not a primarily dermatologic disease, during the pandemic period, it was the most popular subject among Turkish dermatologists. We believe that this study will guide young dermatologists in planning and publishing their work.
Ethics
Ethics Committee Approval: Since it did not involve patient data, the study was not applicable for ethical board approval.
Informed Consent: It wasn’t obtained.
Authorship Contributions
Concept: B.B., G.K., E.A., Design: B.B., G.K., E.A., Data Collection or Processing: B.B., G.K., E.A., Analysis or Interpretation: B.B., G.K., E.A., Literature Search: B.B., G.K., E.A., Writing: B.B., G.K., E.A.
Conflict of Interest: The authors declared that they have no conflict of interest.
Financial Disclosure: The authors declared that this study received no financial support.
