Summary: In his latest blog Professor Harden looks at the latest edition of the AMA Manual of Style, the issue of civic professionalism, publication of controversial ideas, reducing the length of doctor training, the emergence of lifestyle medicine as a new speciality, and more Description:
What’s new in writing style for publication?
The AMA Manual of Style, a JAMA publication, is an authoritative guide for authors and editors. Examples of recommended changes in the new edition are
  • The hyphen has been removed from email. The hyphen is retained in other e-hyphen compounds such as e-book.
  • Publisher location for books and reports will no longer be required (This seems to me to be a much needed change given that many publishers have more than one location and determining which location is appropriate can be challenging. It is also sometimes difficult to determine, particularly for online resources)
  • No period should follow a DOI when it is included for journal references. The risk is that the period, if used, becomes part of the DOI itself when copied.
  • In reference lists the URL will be the last item following dates posted/accessed. No period should follow it.
  • “They” can be used as a singular pronoun.
  • The emphasis is on academic degrees. Fellowships, honorary degrees and other awards should not be included.
  • “Low income”, “Limited income”, “Resource limited”, “Resource poor” and “Transitional” are preferable to the use of the terms “First world/Third world” and “Developed/Developing”
  • “Health care” is preferable to “Healthcare” or “Health-care”
Iverson, C., Christiansen, S. & Flanagin, A. 2018. Implemented Updates. AMA Manual of Style. American Medical Association. JAMA Archives Journals.

Should civic professionalism be a concern?
In our book The Eight Roles of the Medical Teacher we describe the role of the teacher as a professional. This includes a responsibility to evaluate one’s own competence and to keep up to date as a teacher. Also included is the responsibility to consider one’s wellbeing. A fourth, perhaps more controversial responsibility we describe as civic professionalism. Does the teacher have responsibility, for example, to issues relating to climate change? The ASPIRE-to-Excellence social accountability panel added this to what is expected in terms of social accountability of a medical school. These notions of wellbeing and civic responsibility featured prominently at the recent AAMC meeting in Austin, Texas. The controversial role of medical schools and students in tackling issues relating, for example, to gun violence was highlighted.

The journal of controversial ideas
This new journal to be launched next year is the product of an international group of university researchers who feel that free intellectual discussion on tough issues is being hampered by a culture of fear and self-censorship. The journal allows articles on sensitive debates to be written under pseudonyms. In a BBC Radio 4 documentary Professor Jeff McMahan explained the motive “The need for more open discussion is really very acute. There’s greater inhibition on university campuses about taking certain positions for fear of what will happen”. I am not sure about the value of this new journal.  In the Medical Teacher issue on The Future Medical School, October 2018, would we have had more criticism of current practices and different recommendations as to the future if the articles had been anonymous?

Rosenbaum, M. 2018. Pseudonyms to protect authors of controversial articles. BBC News. Accessed on 16/11/2018 at

Reducing the length of training
I have argued for the need to pay more attention to the continuum of education across the different phases and for initiatives to explore reducing the overall length of training. We don’t need 13 years to train an ENT surgeon, a dermatologist, or many other specialists. I was encouraged to hear of the progress with a 10 year old pilot project reported at the AAMC meeting in Austin in November. The aim is to link undergraduate and postgraduate education as a continuous pathway and not as independent stages and to move from a time-based to competency-based model where time to train is variable. While there are clearly logistical challenges in students moving through the programme at different rates the project demonstrated that it is possible to attract students to a specialty early in their career and to accelerate their path. Assessment approaches adopted are key to the success of the initiative and it does involve a change in mindset.

Is lifestyle medicine emerging as a new medical specialty?
This was a question raised in the British Medical Journal 27th October 2018 by Anna Sayburn. The Lifestyle Medicine Global Alliance has defined  lifestyle medicine as “an evidence based medical specialty” that uses “lifestyle therapeutic approaches” to prevent, treat, or modify non-communicable chronic disease. It is argued that lifestyle medicine should not be regarded as complementary or alternative but as mainstream. From the education perspective the question is whether lifestyle medicine should be taught as a new specialty or integrated into other medical specialties.

Publishing peer reviews along with article
Jessica Polka and colleagues writing in Nature call on journals to sign a pledge to publish, along with articles, reviewers’ anonymous comments so that this becomes part of the official scientific record. As representatives of the UK Wellcome Trust and the Howard Hughs Medical Institute (HHMI) in Chevy Chase, Maryland – and ASAPbio, a non-profit organisation that encourages innovation in life-sciences publishing, they are convinced that publishing referee reports would better inform authors and readers, improve review practices and boost trust in science. Right now, less than 3% of scientific journals allow peer reviews to be published. Polka et al argue that the value of published review reports to referees, authors, the public and editors far outweighs the risks and toil and that in an ideal world, all published papers would be accompanied by the contents of their peer-reviewed reports.

CrossRef began assigning DOIs for peer reviews in late 2017, and reviewer reports (with or without reviewer identities) can be archived in PubMed Central.

A feature of AMEE MedEdPublish ( is the publication, along with the paper, of the reviews by members of the review panel and by other readers of the journal.

Polka, J.K., Kiley, R., Konforti, B., Stern, B. & Vale, R.D. 2018. Publish peer reviews. Nature. 560, 545-7.

World’s safest places revealed
With my overseas trips in mind I was interested to read the recent Which report on the safest destination countries ( I was surprised to read that parts of the Middle East and North Africa are safer by a range of measures than some other destinations. Based on the World Economic Fund Safety Index the safest ten, in this order, were Iceland, UAE, Singapore, Spain, Australia, Canada, Japan, Morocco, Jordan, and Barbados. The US came 15th on the list.