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Opinion |
1 Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
Received July 10, 2003; accepted after revision September 16, 2003.
Address correspondence to M. J. Halsted.
The Problem
This vignette illustrates a growing problem in academic medicine: as digital publishing and dissemination of intellectual property becomes more efficient and more widely used, the procedure for assigning credit to authors of digital material has become less well defined. The risk is that authors, uncertain whether they will receive due credit for their contributions, will withhold digital content. If this happens we will all suffer, for access to new material will be restricted. This would be an unfortunate and ironic consequence of the digital publishing era—an era that ought to bring about rapid and unfettered access to new content.
At the 2003 meeting of the Society for Pediatric Radiology in San Francisco, I was asked to speak at a workshop about radiology resources on the Internet. One of the specific topics I was asked to address was how to convince all members of the radiology department to contribute to the departmental digital teaching file. It seems that many departments suffer from a lack of staff participation in collaborative departmental case collections.
The Solution
Unfortunately, I have no magic bullet. In fact, not everyone in my department actively contributes cases to our digital teaching file. However, I think that the days are numbered when radiology staff would keep films in their offices on dusty shelves and bring them out only for giving talks, presenting conferences, or publishing articles. Perhaps those days have already ended. Even in filmless departments possessing robust easy methods for capturing and storing digital images from PACS (picture archiving and communication systems), I believe that the sequestered hard drives housing saved images deep in the recesses of professors' offices will become a thing of the past.
Several reasons account for this change. The most obvious is that access to images during the digital era will only continue to improve. In the past, interesting films were often copied and then left to mold in basements or serve as ballast in automobile trunks, but digital systems allow rapid and reliable copying and archiving of cases. Locating interesting cases in one's own institution is becoming easier with the advent of dictation search systems. Internet search engines and prolific Web-based digital teaching files have made the task much easier and vastly increased the breadth and speed of possible searches. Over time, the best examples of particularly rare cases will come to exist in cyberspace, rather than on a few warehouse or office shelves and in subspecialty textbooks. I welcome this change, which is catalyzed by emerging technologies.
As a corollary, another impetus for change will be that academic credit will be given to those who contribute to digital teaching files. I believe academic institutions will also recognize the value of contributions to learning in cyberspace and will not reserve promotional credit for conventional publications and numbers of lectures given. Specific examples of this phenomenon already exist. For example, the authors of articles written for the Virtual Hospital (available at www.vh.org, last accessed December 8, 2003) can obtain at any time an account of the number of "hits" their articles have received, the total number of pages read in their online textbooks, the total number of visitors to their textbooks, the daily usage, a top-20 list of pages viewed, the pages where users typically entered and left their textbooks, a top-20 list of sites that referred users to their textbooks, a chart showing usage of their pages by country, and a list of words users typed into Internet search engines to find information in their textbooks. This ability to quantify the usage of digital content may facilitate the assessment of the contributions made by authors when their institutions consider their overall academic productivity. I have anecdotal evidence that several academic institutions have begun to weigh digital contributions favorably during the promotion and tenure review process for members of their staffs.
However, a few issues need to be addressed when digital contributions to academic literature in the form of online articles, Web sites, and teaching files become more widely accepted as indicators of academic productivity.
Digital materials are often not peer-reviewed, and an objective method of assessing their academic merit is needed. Counting the number of hits received by a Web site, article, or teaching case may offer some information regarding the popularity of the content offered by these resources, but simple quantification of hits would not accurately assess academic value. We have all received solicitations promising donations to worthy causes in exchange for visiting a Web site—clearly, our visiting a site does not always indicate that we endorse its content. Academic credit could be awarded to authors based on the use of their digital content in publications, conference presentations, lectures, and teaching files rather than on the number of hits their sites receive. That is, the value of digital content would be determined on the basis of its usefulness to the academic world. Such an approach would simply represent an extension of the current system used by some institutions, wherein the number of citations an author's work receives in the Index Medicus is one of the items reviewed when the author is being considered for academic promotion. References to digital material would be tracked by this approach in the same manner as that by which references to printed literature are being tracked already.
A second method would involve the establishment of committees consisting of academic peers who would judge the academic merit of digital materials much as reviewers currently judge articles submitted for publication in print journals and rank abstracts submitted for presentation at academic meetings. The endorsement of digital content by such committees would serve as objective validation of the academic worthiness of digital content and could serve as one measure on which an academic institution could base its assessment of academic staff performance.
It is just as time-consuming to produce digital academic materials as to produce written ones. Under the traditional system, authors and institutions are compensated for this time via various forms of academic credit. They may receive regional, national, and international recognition; an increased likelihood of grant funding; academic promotion; and tenure. These same rewards can be offered to authors of digital academic materials after methods of assessing academic merit are developed and become widely accepted.
Once academic credit for digital contributions becomes commonplace, the idea of saving excellent cases in a file, film-based or otherwise, will seem pointless. I know of no one in academic radiology who was promoted because they had the largest private collection of cases illustrating a particular condition. By contrast, many have been promoted based in part on their contribution of such cases to the printed medical literature. This tradition that rewards the sharing of intellectual property will undoubtedly continue while we move to a digital format; those who share the best cases will continue to be recognized and promoted.
However, the ease with which digital materials can be copied and distributed raises the issue of proper attribution of credit—as academic promotion becomes more closely tied to contributions to the digital literature, it will become increasingly important to document the source of digital materials accurately. In principle, this documentation should be done the same way as under the current system: An author wishing to use digital content produced by another author should seek written permission and give written credit to the original author in publications, lecture notes, or new digital content. If the secondary author is to receive financial compensation for the secondary written or digital materials, then some mechanism is needed for the primary author to receive a fair percentage of that financial compensation as well. In practice, this procedure will rely in part on the honesty and integrity of secondary authors. Methods exist for digitally stamping figures and text so that their origin is more easily determined (such as imbedding a digital watermark in images), but it will probably always be easy to circumvent such security measures.
Although this issue is real, one must bear in mind that the photocopy machine and scanner allow written text and images to be imported to new documents easily and that many written journals are now available online, which makes it even easier to copy images and text of articles that originally appeared in written form. Few would argue that this is a compelling reason for reversing the trend toward making written materials available online. Indeed, I would argue that although digital materials are more easily plagiarized than written ones, the increasing use of digital technology to present images and text by no means represents a new opportunity for plagiarism. Rather, it continues a trend that began with the invention of the photocopy machine, or perhaps even with the invention of the stylus and papyrus. Hand-written plagiarism is certainly as old as written communication itself.
Thus, rather than seek to develop perfect methods to prevent unauthorized use of digital materials, we should take advantage of our ability to distribute digital materials rapidly and broadly. Specifically, we should clearly mark digital academic material with authorship information to make it as easy as possible for citing authors to attribute proper credit and encourage wide distribution and use of that material. The entire academic community, including authors, would benefit from this approach. At the same time, however, we should recognize that digital plagiarism represents a critical violation of the trust of the academic community and maintain severe academic and legal penalties for it.
Conclusion
Traditionally, academic squirrels have never truly been rewarded until they have shared their best cases with others. With the advent of digital technology, academic staff should not feel threatened that their best cases will now be easier to steal and copy. Instead, they should rejoice that the process of sharing instructive cases is getting easier all the time and that if they participate in that sharing, they stand to benefit not only as contributors to, but also as recipients of, an unprecedented improvement in access to the most instructive images radiology has to offer. Clearly, technologic innovations allowing instantaneous copying and dissemination of digital images and text can facilitate the rapid and efficient transfer of the best intellectual capital to a wide readership. By developing methods to encourage more authors to participate and by rewarding them for their participation, we can optimize the potential of new digital technologies. Ultimately, we will gain powerful new resources and tools from this process—tools that we can use to improve the quality of care we provide for our patients.
References
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