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Am Fam Physician. 2008;77(9):1226

The AFP Authors' Guide says that we do not consider articles written by medical or other students, and that we ask that any resident wishing to write for us team up with an experienced physician who will serve as first and corresponding author. Because this policy occasionally raises questions, I would like to present the reasoning behind it.

Our first responsibility is to the readers. Our readers depend on us to provide them with current, accurate, authoritative, evidence-based information in a practical format that they can use to help improve patient care. Writing good clinical reviews is hard work. It is especially difficult when writing for AFP because of the added stipulations we ask for, such as using selected evidence-based resources, creating a table of key clinical recommendations that is rated based on our Strength of Evidence Taxonomy, writing a patient education handout, and responding to pages of peer reviewer comments.

Writing a clinical review includes more than just the writing process. In fact, the writing is secondary to several other, more important factors: 1) having clinical expertise and being familiar with current thinking on the topic, along with all its nuances and controversial points; 2) comprehensively searching the medical literature; 3) being familiar with high-quality sources of evidence-based, clinical information; 4) critically evaluating the information; 5) synthesizing the information in a coherent way; 6) being familiar with how to navigate the peer review process; and 7) conveying clinical information to our primary care audience in a practical, accessible way.

Admittedly, there are gifted medical student and resident authors; and, in the past, we have published articles with residents serving as first authors. However, almost by nature, there are few medical students or residents who have the combination of skills needed to search, evaluate, and synthesize the medical literature, all the while tempered by clinical experience. However, clinical experience alone does not qualify someone as a good author. For this reason, we encourage any physician who has not written a published article to team up with an experienced author, much like a junior researcher who works under a mentor, to gain experience with all the steps that go into writing and publishing a clinical review article.

An analogy I use is that writing for AFP is like doing grand rounds for 200,000 physicians or like doing a main-stage presentation for 1,000 attendees at the American Academy of Family Physicians' Scientific Assembly. Ordinarily, you would not ask a novice to do such a presentation.

As for the claim that a resident author could do the work under the supervision of an experienced faculty member, I use the analogy of precepting an inexperienced resident in the office: residents can come out of the examination room with a convincing presentation, which you can review and approve. However, unless you perform the history and examination yourself, similar to doing the literature review and analysis for an article, you may not be aware of important pieces that are missing or of misinterpretations of the evidence presented. And, as a final analogy, we do not hand surgeons-in-training the scalpel during their first major operation, without the benefit of previously first-assisting.

For the reasons mentioned above, we expect experienced authors to serve as first and corresponding author. It is humbling to note how many readers put into practice the information they read in AFP. Our authorship policy is one way to help ensure that the information is accurate and clinically useful.

At AFP, we seek authors who have expertise in the skills outlined above. We encourage them to help develop the next generation of authors by mentoring them through the long, hard process of writing a good evidence-based review. And, we encourage aspiring resident authors, fellows, and physicians who have not written published articles to serve as coauthors first, thus gaining necessary experience, before venturing out on their own. We trust that this policy will ultimately benefit our authors, our readers, and the many patients they care for.

editor's note: Dr. Siwek is editor of American Family Physician.

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