U.S. Military Graduate Education, Air Force Institute of Technology-Civilian Institute, Wright-Patterson Air Force Base, OH 45433-7765, USA.
Conflict and Health Research Group, King's College London, Strand, London WC2R 2LS, UK.
Mil Med. 2022 Jul 1;187(7-8):e837-e845. doi: 10.1093/milmed/usab317.
There has been external criticism of the compliance of military health personnel with internationally agreed principles in military medical ethics (MME). In response, a number of authors have called for clarity on the principles and topics within the domain of MME. This complements an increased acknowledgment of the need for education in MME for military health personnel. Our paper utilizes bibliometric techniques to identify key themes in MME to inform the development of a curriculum for this subject.
We designed a search strategy to find publications over the period January 1, 2000-December 31, 2020 in the domain of MME from the three databases, PubMed, Web of Science, and Scopus, using the search string (ethic* OR bioethics* OR moral*) AND military AND (medic* OR health*). We obtained a total of 1,115 publications after duplication removal. After exclusion based on topic, year, and study design, we analyzed a total of 633 publications using Scopus's embedded analysis tool and the software VOSViewer. We generated a co-occurrence word map from the abstracts of each of the publications. We deduced themes of MME based on the clusters shown in the word map, and we categorized each publication into one of these themes to analyze the change of themes over time.
We observed a 10-fold increase in annual publications on MME between 2000 and 2020. The majority of papers were written by U.S. (72%) and UK (13%) authors, although a total of 15 countries were represented. After using VOSViewer to identify co-occurring keywords in titles and abstracts from these publications, nine themes were identified: biomedical research, care to detained populations, disaster/triage, mental health, patient-focused foundations, technology, dual loyalty, education/training, and frameworks. The relative proportion of each of these themes changed over the study period, with mental health being dominant by the end.
This study has identified key themes that might inform the development of a curriculum for teaching MME. It is noticeable that the majority of themes cover MME from the perspective of professional practice on military operations; noting, the research and technology themes also pertain to the generation of knowledge for military operations. There were a limited number of publications covering practice in the non-deployed or garrison settings, and these were codified under the themes of "framework" and "dual loyalty". The results are skewed toward English-speaking countries and exclude non-academic publications. Further work will search for other open-source information and non-English publications. To our knowledge, this exploratory bibliometric analysis on MME in the academic literature is the first of its kind. This article has demonstrated the use of bibliometric techniques to evaluate the evolution of knowledge in MME, including the identification of key themes. These will be used to support further work to develop a curriculum for the teaching of MME to military medical audiences.
外界对军事医务人员遵守国际公认的军事医学伦理学（MME）原则提出了批评。有鉴于此，一些作者呼吁明确 MME 领域的原则和主题。这是对军事医务人员接受 MME 教育必要性的认识不断提高的补充。我们的论文利用文献计量学技术来确定 MME 中的关键主题，以为这门学科的课程开发提供信息。
我们设计了一个搜索策略，以在 2000 年 1 月 1 日至 2020 年 12 月 31 日期间，从三个数据库 PubMed、Web of Science 和 Scopus 中查找 MME 领域的出版物，使用的搜索字符串为（ethic* OR bioethics* OR moral*）AND military AND （medic* OR health*）。在重复项删除后，我们共获得了 1115 项出版物。根据主题、年份和研究设计进行排除后，我们使用 Scopus 的嵌入式分析工具和 VOSViewer 软件对总共 633 项出版物进行了分析。我们从每篇论文的摘要中生成了一个共现词图。我们根据词图中显示的聚类来推断 MME 的主题，并将每篇论文归入这些主题之一，以分析主题随时间的变化。
我们观察到 2000 年至 2020 年期间，关于 MME 的年度出版物数量增加了 10 倍。大多数论文是由美国（72%）和英国（13%）的作者撰写的，尽管总共涉及了 15 个国家。在使用 VOSViewer 识别这些出版物的标题和摘要中的共现关键词之后，确定了九个主题：生物医学研究、拘留人口的护理、灾难/分诊、心理健康、以患者为中心的基础、技术、双重忠诚、教育/培训和框架。这些主题中的每一个的相对比例在研究期间都发生了变化，最终心理健康成为主导。
本研究确定了关键主题，这些主题可能为教授 MME 课程的开发提供信息。值得注意的是，大多数主题都从军事行动中专业实践的角度涵盖了 MME；需要指出的是，研究和技术主题也涉及为军事行动生成知识。只有少数涉及非部署或驻军环境下的实践出版物，这些出版物被归入“框架”和“双重忠诚”主题。结果偏向于英语国家，并且排除了非学术出版物。进一步的工作将搜索其他开源信息和非英语出版物。据我们所知，这是对学术文献中 MME 的探索性文献计量分析，属首例。本文展示了使用文献计量学技术评估 MME 中知识的演变，包括确定关键主题。这些将用于支持进一步的工作，以为军事医疗受众教授 MME 课程开发提供支持。
