Impact of limited access to plastic surgery journals on clinical and research output in low- and middle-income countries.

Most plastic surgery research originates in high-income countries (HICs). This does not reflect the distribution of need in the global population, and is underpinned by a lack of representation of authors working in low- and middle-income countries (LMICs). The aims of this study were to explore the barriers to publishing, including access to plastic surgery journals, among plastic surgeons working in LMICs. These themes were explored through an online questionnaire distributed via the British Foundation for International Reconstructive Surgery and Training global mailing list and professional networks across LMIC (as defined by the World Health Organization). We received 188 responses from 21 countries. Although 73% felt that publishing was beneficial to career progression, 47% of the respondents had never published as a first author, and 36% had never published as a co-author. The most common barriers to publishing were patient workload (46%), lack of guidance/mentorship (38%), and article publishing charges (35%). With regards to access to plastic surgery journals, 50% found it challenging to access this resource and cited paywalls (84%), inadequate library access (70%), and poor knowledge of resources (20%) as the most common barriers. Furthermore, 94% believed that making plastic surgery journals more accessible would increase research productivity. Common impacts of poor access to journals were difficulty staying up to date (65%), finding specific techniques (52%), and accessing references/research resources (43%). We concluded that a range of interventions is required to support plastic surgery research in LMICs. These include improving access to surgical journals, research skills, mentorship, task sharing, and removing article publishing charges.