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Editor,—The mission of academic medical centres typically includes three distinct goals: providing patient care, educating future doctors, and acquiring new medical knowledge.1 Academic medical centres seek excellence in each of the three areas to distinguish themselves as outstanding in the local community, region, and nation.2 3 Factors responsible for poor academic performance in less privileged centres include a failure in academic motivation, lack of pressure for publication, and limited research funding.4 Ours is a tertiary neonatal care centre for North Queensland, Australia. Geographically, we are isolated from the well established academic centres in Australia. The nursery was almost closed down due to some unfortunate events in 1995 resulting in our appointment in 1996 as the new neonatologists. We were expected to get the nursery functioning to its full potential (eight ventilators, on site surgery, regional transport) and hopefully gain some academic status to justify being the regional teaching hospital. With lack of time, funding, academic support, and all registrars joining us from developing countries as new trainees, research as a goal seemed almost impossible to achieve. The easiest thing was to put more effort on clinical rounds (“patient care”), devote additional time towards rare, interesting, or clinically important cases (“clinical education”), and to publish these case reports as an academic exercise while “acquiring new knowledge”.
Within a period of four years, 15 case reports have been published in peer reviewed journals by our team of five registrars working their usual 80–100 hours per fortnight. The quick rewards have motivated the team further, resulting in an additional 27 research projects being either published or presented at major international scientific meetings. The projects cover topics ranging from taping of intravenous cannulas, and adenosine infusion for pulmonary hypertension, to a randomised, controlled trial of erythromycin for facilitating feed tolerance in neonates. Motivated by our academic output (52 projects within four years), two students from the local university have completed the clinical components of their degrees (doctorate and master's) in our nursery.
We strongly believe that increased motivation of registrars due to quick publications serving as quick reward for their hard work is the reason for our academic output. We are aware that case reports may not be counted as “research”, or serve as a marker of “academic quality”. As long as they are not published in the “yellow pages”, they do provide us a very strong academic tool for motivating our registrars towards research.5